Prevalence of conventional risk factors in Jordanians with coronary heart disease: the Jordan Hyperlipidemia and Related Targets Study (JoHARTS)

BACKGROUND: The prevalence of the major conventional cardiovascular risk factors - cigarette smoking, diabetes mellitus, hypertension, and dyslipidemia - among coronary heart disease (CHD) patients in the Middle East has not been studied extensively. METHODS AND RESULTS: The Jordan Hyperlipidemia And Related Targets Study (JoHARTS) evaluated the prevalence of the 4 conventional risk factors in 5000 individuals including 1692 (34%) women. CHD was present in 1534 (31%) individuals (1202 men and 332 women). Among CHD patients, at least one risk factor was present in the majority of men (95%) and women (96%). Compared with women who had CHD, men had significantly higher prevalence of smoking (45% vs. 11%, p < 0.0001) and low levels of high-density lipoprotein cholesterol (60% vs. 39%, p < 0.0001), and lower prevalence of diabetes (40% vs. 64%, p < 0.0001), hypertension (38% vs. 63%, p < 0.0001), and hypercholesterolemia (19% vs. 27%, p = 0.003). Diabetes was more prevalent among men and women with CHD than men and women without CHD (40% vs. 18% for men, and 64% vs. 24% for women p < 0.0001). Similarly, smoking was more prevalent in men and women with CHD than those without CHD (45% vs. 32% for men, and 11% vs. 7%, p < 0.0001). Low levels of high-density lipoprotein cholesterol were also more prevalent in men with CHD than those without CHD (60% vs. 51%, p < 0.001) and among women with CHD than those without CHD (39% vs. 24%, p = 0.0001). Prevalence rates of hypertension, hypercholesterolemia, and hypertriglyceridemia were not different among individuals with or without CHD. CONCLUSION: These results further challenge claims that patients with CHD commonly lack conventional risk factors. The great majority (>95%) of CHD patients studied have at least one risk factor. Detection, evaluation and management of these factors are essential steps to control CHD in the region.     

Fasting plasma glucose in non-diabetic elderly women predicts increased all-causes mortality and coronary heart disease risk

Aim: To confirm the hypothesis that upper normal plasma glucose levels in non‐diabetic subjects are independently predictive of mortality and cardiovascular disease (CVD). Methods: ’The study reports on 113 months’ follow‐up in a prospective study of CVD in the Australian elderly, The Dubbo Study. The cohort, first examined in 1988–89, consisted of 2805 men and women 60 years and older. Of the cohort, 2419 (86%) were defined as non‐diabetic. The prediction of outcomes by quartile of fasting plasma glucose was examined in a Cox proportional hazards model, after linkage to hospital and death records. Results: All‐causes mortality increased progressively across quartile of fasting plasma glucose in both sexes, reaching statistical significance only in women. Coronary heart disease (CHD) incidence increased similarly, the increases being proportionately greater in women. Ischaemic stroke did not show a consistent gradient with fasting plasma glucose. After adjustment for age and other risk factors, all‐causes mortality, CHD and ischaemic stroke incidence were not significantly related to plasma glucose in men. In women, all‐causes mortality and CHD incidence showed a significant gradient with glucose quartile. Hazard Ratio (95% confidence intervals) for death in glucose Quartile IV (5.3–6.0 mmol/L) was 1.49 (1.03–2.14) and for CHD incidence was 1.52 (1.08–2.15). Subjects in the upper quartiles of fasting plasma glucose showed a clustering of overweight, hypertension, elevated serum triglycerides, reduced high density lipoprotein cholesterol and excess of small dense low density lipoprotein, suggestive of the Insulin Resistance Syndrome. Conclusion: Fasting plasma glucose levels in the upper normal range in non‐diabetic elderly subjects appear to be associated with increased all‐causes mortality and CHD, especially in women.     

Relationship between changes in neck circumference and cardiovascular risk factors

OBJECTIVE: Neck circumference (NC) is a simple screening measure for identifying overweight and obese patients. The main aim of the present study was to determine the relationship between changes in NC and changes in cardiovascular risk factors by evaluating some components of the metabolic syndrome. METHODS: The present longitudinal cohort study included 364 subjects (155 men and 209 women) with no known major medical conditions and who were not receiving any medication. Main indicators included NC, waist circumference, waist-to-hip ratio, body mass index, and fasting lipoprotein, glucose and uric acid levels. RESULTS: Pearson's correlation coefficients indicated a significant association between changes in NC and changes in body mass index (men, r=0.67; women, r=0.69; each, P<0.0001), waist circumference (men, r=0.69; women, r=0.56; each, P<0.0001), waist-to-hip ratio (men, r=0.27; women, r=0.33; each, P<0.0001), and total cholesterol (men, r=0.68; women, r=0.64; each, P<0.0001), low density lipoprotein cholesterol (men, r=0.58; women, r=0.59; each, P<0.0001), triglyceride (men, r=0.48; women, r=0.44; each, P<0.0001), glucose (men, r=0.51; women, r=0.44; each, P<0.0001) and uric acid (men, r=0.42; women, r=0.47; each, P<0.0001) levels. The relative changes in NC contributed to independent significant changes in total cholesterol (8% for men and 1% for women), low density lipoprotein cholesterol (1% for men and 1% for women) and triglycerides (23% for men); it did not significantly contribute to changes in high density lipoprotein cholesterol, glucose or uric acid levels. CONCLUSION: Changes in NC are positively correlated with changes in some factors of the metabolic syndrome and, therefore, are correlated with changes in the risk of cardiovascular disease.     

Nonfasting cholesterol and triglycerides and association with risk of myocardial infarction and total mortality: the Copenhagen City Heart Study with 31 years of follow-up

Abstract. Langsted A, Freiberg JJ, Tybjærg‐Hansen A, Schnohr P, Jensen GB, Nordestgaard BG (Herlev Hospital, Herlev; University of Copenhagen; Bispebjerg Hospital; and Rigshospitalet, Copenhagen Ø, Denmark). Nonfasting cholesterol and triglycerides and association with risk of myocardial infarction and total mortality: the Copenhagen City Heart Study with 31 years of follow‐up. J Intern Med 2011; 270 : 65–75. Objectives. We compared the ability of very high levels of nonfasting cholesterol and triglycerides to predict risk of myocardial infarction and total mortality. Design. Prospective study from 1976 to 1978 until 2007. Setting. Danish general population. Participants. Randomly selected population of 7581 women and 6391 men, of whom 768 and 1151 developed myocardial infarction and 4398 and 4416 died, respectively. Participation rate was 72%, and follow‐up was 100% complete. Less than 2% of participants were taking lipid‐lowering therapy. Results. Compared to women with cholesterol <5 mmol L^?1, multivariate‐adjusted hazard ratios for myocardial infarction ranged from 1.3 [95% confidence interval (CI): 0.9–1.8] for a cholesterol level of 5.0–5.99 mmol L^?1 to 2.5 (95%CI: 1.6–4.0) for cholesterol ≥9 mmol L^?1 (trend: P < 0.0001). Compared with women with nonfasting triglycerides <1 mmol L^?1, hazard ratios for myocardial infarction ranged from 1.5 (95%CI: 1.2–1.8) for triglycerides of 1.0–1.99 mmol L^?1 to 4.2 (95%CI: 2.5–7.2) for triglycerides ≥5 mmol L^?1 (p<0.0001). In men, corresponding hazard ratios ranged from 1.2 (95%CI: 1.0–1.5) to 5.3 (95%CI: 3.6–8.0) for cholesterol (P < 0.0001) and from 1.3 (95%CI: 1.0–1.6) to 2.1 (95%CI: 1.5–2.8) for triglycerides (P < 0.0001). Increasing cholesterol levels were not consistently associated with total mortality in women (trend: P = 0.39) or men (P = 0.02). By contrast, compared with women with triglycerides <1 mmol L^?1, multivariate‐adjusted hazard ratios for total mortality ranged from 1.1 (95%CI: 1.0–1.2) for triglycerides of 1.0–1.99 mmol L^?1 to 2.0 (95%CI: 1.5–2.9) for triglycerides ≥5 mmol L^?1 (trend: P < 0.0001); corresponding hazard ratios in men ranged from 1.1 (95%CI: 1.0–1.2) to 1.5 (95%CI: 1.2–1.7) (P < 0.0001). Conclusions. Stepwise increasing levels of nonfasting cholesterol and nonfasting triglycerides were similarly associated with stepwise increasing risk of myocardial infarction, with nonfasting triglycerides being the best predictor in women and nonfasting cholesterol the best predictor in men. Even more surprisingly, only increasing levels of nonfasting triglycerides were associated with total mortality, whereas increasing cholesterol levels were not.     

Triglyceride/HDL-cholesterol ratio is an independent predictor for coronary heart disease in a population of Iranian men

Background and aimsTo determine whether triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-C), which has been shown to be an indicator of the metabolic syndrome (MetS) and insulin resistance, can predict coronary heart disease (CHD) independently of total cholesterol (TC) and other risk factors in an Iranian population with a high prevalence of MetS and low HDL-C.Methods and resultsBetween February 1999 and August 2001, 1824 men ≥40 years old, free of clinical cardiovascular diseases at baseline, were followed. Baseline measurements included serum level of TC, HDL-C, TG and risk factors for CHD including age, systolic and diastolic blood pressure, body mass index, waist circumference, diabetes, smoking and a family history of premature cardiovascular diseases. During a median follow up of 6.5 years until March 2007 (11,316 person-years at risk), a total of 163 new CHD events (27 fatal and 136 nonfatal) occurred. The prevalence of MetS in subjects with TG/HDL-C ≥6.9 (top quartile) reached 63.6% versus 3.0% in those with TG/HDL-C <2.8 (low quartile). According to a stepwise Cox proportional hazard model, including TG and TG/HDL-C quartiles, with TC and other risk factors, men in the top quartile of TG/HDL-C relative to the first quartile had a significant hazard ratio (HR) of 1.75 (95% CI, 1.02–3.00), while TG did not remain in the model.ConclusionThe evaluation of TG/HDL-C ratio should be considered for CHD risk prediction in our male population with a high prevalence of MetS.     

Sex, age, cardiovascular risk factors, and coronary heart disease: a prospective follow-up study of 14 786 middle-aged men and women in Finland

BACKGROUND: Coronary heart disease (CHD) is markedly more common in men than in women. In both sexes, CHD risk increases with age, but the increase is sharper in women. We analyzed the extent to which major cardiovascular risk factors can explain the sex difference and the age-related increase in CHD risk. METHODS AND RESULTS: The study cohort consists of 14 786 Finnish men and women 25 to 64 years old at baseline. The following cardiovascular risk factors were determined: smoking, serum total cholesterol, HDL cholesterol, blood pressure, body mass index, and diabetes. Risk factor measurements were done in 1982 or 1987, and the cohorts were followed up until the end of 1994. The Cox proportional hazards model was used to assess the relation between risk factors and CHD risk. CHD incidence in men compared with women was approximately 3 times higher and mortality was approximately 5 times higher. Most of the risk factors were more favorable in women, but the sex difference in risk factor levels diminished with increasing age. Differences in risk factors between sexes, particularly in HDL cholesterol and smoking, explained nearly half of the difference in CHD risk between men and women. Differences in serum total cholesterol level, blood pressure, body mass index, and diabetes prevalence explained about one-third of the age-related increase in CHD risk among men and 50% to 60% among women. CONCLUSIONS: Differences in major cardiovascular risk factors explained a substantial part of the sex difference in CHD risk. An increase in risk factor levels was associated with the age-related increase in CHD incidence and mortality in both sexes but to a larger extent in women.     

Differential leucocyte count and the risk of future coronary artery disease in healthy men and women: the EPIC-Norfolk Prospective Population Study

Abstract. Rana JS, Boekholdt SM, Ridker PM, Jukema JW, Luben R, Bingham SA, Day NE, Wareham NJ, Kastelein JJP, Khaw K‐T. (Academic Medical Center, Amsterdam, The Netherlands; University of Pittsburgh, Pittsburgh, PA, USA; Leiden University Medical Center, The Netherlands; and Institute of Public Health, University of Cambridge, Cambridge, UK). Differential leucocyte count and the risk of future coronary artery disease in healthy men and women: the EPIC‐Norfolk Prospective Population Study. J Intern Med 2007; 262 : 678–689. Background: We examined the relationship between granulocyte, lymphocyte and monocyte counts and risk of coronary heart disease (CHD) and cardiovascular disease (CVD) in men and women. There is paucity of data on the differential leucocyte count and its relationship with the risk of CHD and CVD. Methods: This prospective study comprised 7073 men and 9035 women who were 45–79 years of age and were residents of Norfolk. United Kingdom. Results: During an average of 8 years of follow‐up we identified 857 incident CHD events and 2581 CVD incident events. Increased total leucocyte count was associated with increased risk for both CHD and CVD. The highest quartile of granulocyte count was associated with increased risk when compared to lowest quartile for CHD (men HR 1.70 95% CI: 1.30–2.21; women HR 1.24 95% CI: 0.91–1.69) and for CVD (men HR 1.46 95% CI: 1.24–1.71; women HR 1.20 95% CI: 1.02–1.42). The association remained unchanged when the analyses were restricted to nonsmokers and when risk was assessed for every 1000 cells L^?1 increase in cell count. In multivariable models, despite adjusting for C‐reactive protein (CRP), the granulocyte count remained an independent predictor of CHD and CVD risk, especially amongst men. Lymphocyte or monocyte counts were not significantly associated with increased risk. In all analyses, additionally adjusting for CRP did not affect the results materially. Conclusions: In conclusion, we found that the higher risk for CHD and CVD associated with increased total leucocyte count seems to be accounted for by the increased granulocyte count.     

Decreased non-esterified fatty acid suppression and features of the insulin resistance syndrome occur in a sub-group of individuals with normal glucose tolerance

Summary To investigate causes of increased triglyceride concentrations in subjects with normal glucose tolerance (determined by oral glucose tolerance testing using World Health Organization criteria) 883 healthy subjects (389 men and 494 women) between 40 and 65 years of age were studied. Subjects were divided by gender into four groups according to 120-min glucose concentrations. Individuals in the highest quartile of glucose concentration had the highest mean triglyceride concentrations (p<0.0001) and highest mean non-esterified fatty acid (NEFA) concentrations (p<0.0001). There was also a clustering of cardiovascular risk factors normally associated with the insulin resistance syndrome in subjects in this group. Regression analysis showed that the most important determinants of triglyceride levels were smoking (men p=0.001, women p=0.005), waist:hip ratio (men p=0.01, women p<0.001) and NEFA suppression (men p=0.02, women p=0.005). NEFAs suppressed 16.7% in women compared to 2.4% in men during the first 30 min of the oral glucose tolerance test (p<0.001). These results show that a clustering of cardiovascular risk factors associated with decreased NEFA suppression occurs in a sub-group of subjects with normal glucose tolerance and that the pattern of NEFA suppression differs between men and women.Abbreviations NEFA Non-esterified fatty acids - IHD ischaemic heart disease - HDL high density lipoprotein - IRS insulin resistance syndrome - VLDL very low density lipoprotein - OGTT oral glucose tolerance test - NIDDM non-insulin-dependent diabetes mellitus - WHR waist-hip ratio     

Risk assessment for coronary heart disease in patients with haemophilia: a single centre study in the United States

In haemophilia, coronary heart disease (CHD) occurs at a similar frequency as in the general population, but the contributing risk factors in haemophilia are incompletely understood. To investigate risk factors and 10‐year CHD risk in a single centre cohort of patients with haemophilia (PWH) ≥20 years old (n = 89). We retrospectively applied the modified Framingham National Cholesterol Education Program/Adult Treatment Panel (NCEP/ATP) III risk prediction equation. Three risk levels were defined: <10% (low), 10–20% (intermediate) and >20% (high). Results were compared to the National Health and Nutrition Examination Survey (NHANES). Mean age in both cohorts was similar. Compared to NHANES, systolic blood pressures were significantly higher in PWH, but current smoking and cholesterol were lower. CHD risk differed significantly between PWH and NHANES (P = 0.005) with a higher proportion of PWH classified at low risk (77.5% vs. 61.0%). The proportion of low risk patients was also significantly higher for severe haemophilia patients compared to non‐severe haemophilia patients (88.6% vs. 66.7%, P = 0.02). Among PWH, and compared to PWH who were hepatitis C (HepC) negative, HepC positive patients had significantly lower cholesterol, LDL and triglycerides. The CHD risk of HepC positive patients differed significantly from NHANES (P = 0.03) with a lower proportion of HepC positives being classified as high risk (5.7% vs. 17.3%). Favourable CHD risk classification in PWH may be influenced by low cholesterol associated with HepC infection. Estimates of CHD risk in PWH by composite scoring may not be accurate and will require studies correlating risk factors with incident CHD.     

Risk factors for non-communicable diseases among older adults in rural Africa

Objective To expand the evidence base on the prevalence of non‐communicable disease (NCD) risk factors in rural Africa, in particular among older adults aged 50 and older. Methods Cross‐sectional study in three rural sites in Malawi, Rwanda and Tanzania. One person was interviewed from each of 665 households selected through a stratified random sampling procedure across the three sites. The questionnaire included socio‐demographic characteristics, smoking and alcohol intake as well as a food frequency questionnaire. Results Smoking rates among older men and women were higher than among adults under 50. While only 2.3% of women under 50 were current smokers, 21.0% of older women smoked (P < 0.0001). Among men, 19.0% of men under 50 smoked versus 36.6% of older men (P = 0.001). Alcohol consumption among older women aged 50 and older (45.0%) was more common (P = 0.005) than among women under 50 (27.6%). Examining a set of five risk factors, more men aged 50 and older (49.5%) had two or more risk factors than men under 50 (25.5%) (P < 0.0001). Similarly, 52.0% of women aged 50 and older had two or more risk factors, versus 24.1% of women under 50 (P < 0.0001). Conclusion Contrary to what is seen in developed country settings, this study reveals high rates of smoking and alcohol consumption among men and women aged 50 years and older in rural Africa that puts them at risk of NCDs. The health of older adults in rural Africa has been neglected, and these findings highlight the importance of reaching out to older adults with messaging regarding diet, smoking, alcohol use and general health.     

Higher Cholesterol Level Predicts Cardiovascular Event and Inversely Associates With Mortality in Hemodialysis Patients: 10‐Year Outcomes of the Q‐Cohort Study

The prevalence of atherosclerotic diseases is higher in hemodialysis patients. The aim of the current study was to investigate associations between cholesterol level and the incidences of cardiovascular disease (CVD) and mortality in hemodialysis patients. A total of 3517 participants undergoing maintenance hemodialysis were followed up for 10 years. Total cholesterol (TC) level was divided into quartile in baseline data. The multivariate analyses were calculated by a Cox proportional hazards model. The incidences of ischemic heart disease (IHD), peripheral artery disease (PAD), and CVD were significantly positively associated with higher cholesterol levels after adjustment for confounding factors (P < 0.01, P = 0.04, and P < 0.01, respectively). Furthermore, the incidences of cancer‐associated mortality and all‐cause mortality were significantly positively associated with lower cholesterol levels after adjustment for confounding factors (both P < 0.01). The lowest TC level at all‐cause mortality risk was 179 mg/dL. From these results, higher TC predicts IHD, PAD, and CVD events, and lower TC predicts cancer‐associated mortality and all‐cause mortality in patients undergoing maintenance hemodialysis.     

Sagittal abdominal diameter compared with other anthropometric measurements in relation to cardiovascular risk

BACKGROUND: Abdominal adiposity has been described as an independent risk factor for coronary heart disease. Sagittal abdominal diameter has been found to be closely related to the amount of visceral adipose tissue. AIM: To compare the sagittal abdominal diameter with other anthropometric measures regarding their relationships to risk factors for coronary heart disease (CHD). DESIGN: A study of 885 men and women participating in a health survey. MEASUREMENTS: Sagittal abdominal diameter, body mass index (BMI), waist and hip circumferences, waist-to-hip ratio, serum concentrations of risk factors for CHD, blood pressure. RESULTS: In men the sagittal abdominal diameter showed stronger correlations to the CHD risk factors serum cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, glucose, insulin, apolipoprotein B (apoB), plasminogen activator inhibitor tissue-type plasminogen activator (t-PA) and lipid-corrected alpha tocopherol, and to systolic and diastolic blood pressures than the other anthropometric measurements. In women, compared with the other anthropometric measurements the sagittal abdominal diameter was more strongly correlated to serum cholesterol, LDL cholesterol, LDL/HDL (high-density lipoprotein), apo B and t-PA, and to systolic and diastolic blood pressure. The sagittal abdominal diameter showed a stronger correlation to 'total risk' for cardiovascular disease (+ 0.66 for men, 0.62 for women), than waist circumference (+ 0.63 for men, + 0.57 for women) and waist-to-hip ratio (+ 0.61 for men and +0.48 for women; P <0.0001 for all correlations). This diameter was also more strongly correlated to 'metabolic risk' (+ 0.64 for men, + 0.59 for women) than waist circumference (+ 0.60 for men, + 0.59 for women) and waist-to-hip ratio (+ 0.58 for men, + 0.52 for women)(P < 0.0001 for all correlations). In a regression analysis including the anthropometric measurements and the risk values, the sagittal diameter was the strongest measure of cardiovascular risk in both men and women. CONCLUSIONS: Among both men and women in this study the sagittal abdominal diameter showed stronger correlations to cardiovascular risk and to other risk factors in the metabolic syndrome than other anthropometric variables such as waist circumference, waist-to hip ratio and BMI.     

Modulation of high-density lipoproteins in a population in istanbul, Turkey, with low levels of high-density lipoproteins

The extent to which high-density lipoprotein (HDL) cholesterol levels can be increased in patients with low HDL cholesterol is important because low HDL cholesterol levels increase the risk of coronary heart disease (CHD). During the past 14 years, we have assessed risk factors in Turks, a population in which extremely low HDL cholesterol levels (mean 36 mg/dl in men, 42 mg/dl in women) are a prime CHD risk factor. Although genetically determined to a significant extent, these low HDL cholesterol levels can be modulated by lifestyle factors, as in other populations. We measured the HDL cholesterol levels in men and women residing in Istanbul at 3 time points: 1990 to 1993, 1996 to 2000, and 2003. The mean HDL cholesterol levels increased from 45.3 +/- 9.5 mg/dl in 1990 to 1993 to 49.7 +/- 12 mg/dl in 2003 (p <0.0001) in women, but were virtually unchanged in men (38 +/- 8 vs 39 +/- 10 mg/dl). In contrast to previous years, the HDL cholesterol levels in women in 2003 were markedly affected by education level and socioeconomic status, averaging 56 +/- 9 mg/dl in those with a university education and 48 +/- 12 mg/dl in those with a primary school education. Part of this difference could be explained by less smoking and more exercise and lower body mass index (average 25.6 +/- 4.9 vs 29.7 +/- 5.1 kg/m(2)) of the highly educated women. It is important to note the increase in the prevalence of obesity between the 1990 to 1993 interval and 2003 in men and women, including a remarkable change from 9.4% to 45.2% among women with a primary school education. None of these factors affected the HDL cholesterol levels of men by >2 mg/dl at any of the 3 points. In conclusion, because CHD risk changes by as much as 2% to 4% per 1 mg/dl difference in HDL cholesterol level, the 8 mg/dl difference may reflect as much as a 20% to 30% reduction in CHD risk associated with the benefit of higher education in women. Why education failed to affect the HDL cholesterol levels in Turkish men remains unclear.     

Risk factor control in patients with Type 2 diabetes and coronary heart disease: findings from the Swedish National Diabetes Register (NDR)

Aims Patients with Type 2 diabetes and coronary heart disease (CHD) are infrequently treated to risk factor targets in current guidelines. We aimed to examine risk factor management and control levels in a large sample of patients with Type 2 diabetes with CHD. Methods This was an observational study of 1612 patients with first incidence of CHD before 2002, and of 4570 patients with first incidence of CHD before 2005, from the Swedish National Diabetes Register (NDR). Results In patients with CHD 1–2 years before follow‐up, the achievement of cardiovascular risk factor targets (follow‐up 2002/follow‐up 2005) was: HbA_1c < 7%, 47%/54% (P < 0.01); blood pressure ≤ 130/80 mmHg, 31%/40% (P < 0.001); total cholesterol < 4.5 mmol/l, 47%/60% (P < 0.001); and low‐density lipoprotein‐cholesterol < 2.5 mmol/l, 49%/65% (P < 0.001). Use of medication: antihypertensives, 90%/94% (P < 0.01); lipid‐lowering drugs, 75%/86% (P < 0.001); and aspirin, 85%/89% (P < 0.05). A high prevalence of adverse lifestyle characteristics prevailed (2002/2005): overweight [body mass index (BMI) ≥ 25 kg/m²], 86%/85%; obesity (BMI ≥ 30 kg/m²), 41%/42%; smokers in age group < 65 years, 16–23%/18–19%; as well as waist circumference ≥ 102 cm (men) or ≥ 88 cm (women), 68% in 2005. Conclusions Patients with a combination of Type 2 diabetes and CHD showed an increased use of lipid‐lowering drugs over time, corresponding to improving blood lipid levels. A discrepancy existed between the prevalent use of antihypertensive drugs and the low proportion reaching blood pressure targets. Regretfully, a high prevalence of adverse lifestyle characteristics prevailed. Evidence‐based therapy with professional lifestyle intervention and drugs seems urgent for improved quality of secondary prevention in these patients.     

Serum gamma-glutamyltransferase is associated with arterial stiffness in healthy individuals

Objective Gamma‐glutamyltransferase (GGT) has been reported to be useful in predicting cardiovascular disease. Arterial stiffness measured by brachial‐ankle pulse wave velocity (baPWV) is not only a marker of vascular damage but a significant predictor of cardiovascular events. Gender difference has been reported in the association between GGT and baPWV. We assessed, therefore, the association between GGT and baPWV in a large population and determined whether there was gender difference. Design This cross‐sectional study was conducted at the Asan Medical Centre, Seoul, Republic of Korea. Subjects and measurements Serum GGT, baPWV and conventional risk factors were measured in 10 988 apparently healthy subjects (7248 men, 3740 women) who participated in a routine health screening examination. Results In both men and women, we observed positive linearity between GGT quartiles and body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, fasting plasma glucose, total cholesterol, LDL cholesterol, triglycerides, uric acid, high‐sensitive C‐reactive protein (hsCRP) and homeostatic model assessment of insulin resistance (HOMA‐IR) score (P for trends < 0·001). The proportion of individuals with diabetes, hypertension increased as the GGT quartile increased (P for trends < 0·001). Age‐adjusted mean baPWV increased gradually in both males and females according to GGT quartiles (P for trends < 0·001 in both genders). The odds for higher baPWV (i.e. >75th percentile in each sex) were significantly higher in the highest compared with the lowest GGT quartiles, after adjustment for confounding variables, in both men [odds ratio (OR) = 1·63, 95% CI = 1·21–2·20] and women (OR = 1·56, 95% CI = 1·08–2·27). Conclusions These results suggest that GGT is independently associated with the increased level of arterial stiffness both in men and in women and the association between them appears to be stronger in men compared to women.     

Serum lipids in fathers and sons at middle age: the study of sons to men born in 1913

Abstract. Rosengren A, Eriksson H, Welin C, Welin L (Sahlgrenska University Hospital/Östra, Göteborg; and Lidköpng Hospital, Lidköping; Sweden). Serum lipids in fathers and sons at middle age: the study of sons to men born in 1913. J Intern Med 2003; 254: 126–131. Objective. To relate lipid levels in middle‐aged men to that of their fathers at 50 years of age measured 30 years earlier. Design and subjects. In 1963, 855 men born in 1913 took part in a cardiovascular risk factor survey when they were at 50 years of age. In 1993, 475 sons to these men, aged 44–56, were invited to another examination; 263 of these men were examined (response rate: 56%) and compared with their 217 fathers when they were examined at 50 years of age in 1963. In the 1993 survey, 798 men aged 50, were also examined, from a general population sample of men born in 1943 (response rate: 55%). Setting. City of Göteborg, Sweden. Main outcome measures. Serum lipids in sons as a function of lipids in their fathers. Results. Compared with the men born in 1913, both sons and men born in 1943 had lower mean serum cholesterol, but higher body mass index (BMI) and serum triglycerides. There was a significant relation between serum cholesterol in sons and their fathers (r = 0.25; P < 0.0001). Amongst sons to fathers in the highest cholesterol quartile (>6.9 mmol L^?1), 37% had serum cholesterol above 6.5 mmol L^?1, compared with 16% amongst sons to fathers in the lowest quartile (<5.7 mmol L^?1) [adjusted odds ratio 3.73 (1.52–9.12)]. Sons to fathers with the highest serum cholesterol levels had slightly lower BMI; otherwise there was no relation between serum cholesterol in the father and any other lifestyle or biological risk factor in the sons. Serum triglyceride concentration in the father was unrelated to any variable in the son. Conclusions. There was a moderately strong association between serum cholesterol concentration in fathers and sons at middle age. However, secular trends were also important in determining serum cholesterol concentrations in those born at a later period, indicating a major role of environmental factors.     

Sex and time differences in the associations of non-high-density lipoprotein cholesterol versus other lipid and lipoprotein factors in the prediction of cardiovascular death (The Rancho Bernardo Study)

Non-high-density lipoprotein (HDL) cholesterol (total cholesterol [TC] minus HDL cholesterol) has been suggested as the preferred lipid fraction to predict cardiovascular disease. We compared the ability of lipids, lipoproteins, the ratio of total to HDL cholesterol (TC/HDL), and non-HDL cholesterol to predict fatal coronary heart disease (CHD) and cardiovascular disease in 1,386 women and 1,094 men (mean age 69 years). After 10 years, there were more deaths in men (n = 310) than women (n = 268), but the proportions of deaths attributed to CHD (23% and 25%, respectively) and cardiovascular disease (48% and 47%) were similar. In men, age-adjusted values for non-HDL cholesterol, TC/HDL ratio, and triglycerides each predicted a significantly increased risk of CHD and cardiovascular disease; none of these associations was independent of pack-years of smoking, systolic blood pressure, fasting plasma glucose, body mass index, and physical activity. In women, age-adjusted non-HDL cholesterol levels did not predict CHD or cardiovascular disease events before or after adjusting for these covariates and for estrogen replacement therapy. In women, only the ratio of TC to HDL cholesterol predicted CHD and cardiovascular disease deaths independent of estrogen use and other risk factors. Observed associations were sensitive to time, being evident in women at 3 and 5 years, and lost thereafter, but not apparent before 10 years in men. Thus, non-HDL cholesterol is not superior to individual lipids, lipoproteins, or their ratios in the prediction of cardiovascular death in older adults.     

Cardiovascular risk factors clustering with endogenous hyperinsulinaemia predict death from coronary heart disease in patients with Type II diabetes

Aims/hypothesis. Information on the association of hyperinsulinaemia with coronary heart disease (CHD) in patients with Type II (non-insulin-dependent) diabetes is limited and controversial. Therefore, we carried out a prospective study to examine the predictive value of fasting plasma insulin and “hyperinsulinaemia cluster” with regard to the risk of CHD mortality.¶Methods. At baseline risk factors for CHD were determined in 902 patients aged 45 to 64 years with Type II diabetes not treated by insulin (499 men and 403 women). These patients were followed up to 7 years for CHD mortality.¶Results. Coronary heart disease mortality (16.2 % in men, 9.2 % in women) increased significantly in men with increasing plasma insulin tertiles (p = 0.006) and in both sexes combined (p = 0.010) but not in women (p = 0.090). The predictive value of hyperinsulinaemia with regard to death from CHD was independent of conventional cardiovascular risk factors but not of risk factors clustering with hyperinsulinaemia. By applying factor analysis and principal component analysis we showed that “hyperinsulinaemia cluster” (a factor having high positive loadings for body mass index, triglycerides and insulin; and a high negative loading for high-density lipoprotein cholesterol) was predictive of death from CHD in patients with Type II diabetes (hazard ratio with 95 % confidence intervals 1.43 (1.18, 1.73), p < 0.001).¶Conclusion/interpretation. Our results support the notion that cardiovascular risk factors clustering with endogenous hyperinsulinaemia increase the risk of death from CHD in patients with Type II diabetes not treated with insulin. [Diabetologia (2000) 43: 148–155]     

Risk factors for cardiovascular disease in individuals with diabetes

Coronary heart disease (CHD) is the leading cause of death among individuals with diabetes. However, information on CHD and its association with known risk factors in populations with high rates of diabetes is limited. The purpose of the Strong Heart Study is to quantify CHD and its risk factors among three geographically diverse groups of American Indians who have a high prevalence of diabetes. The study group consisted of 4549 adults between 45 and 74 years of age in 13 Indian communities in Arizona, Oklahoma, and South and North Dakota. Rates of diabetes ranged from 33% to 72% in men and women in the three centers. The prevalence rates of definite myocardial infarction (MI) and definite CHD were higher in man than in women in all three centers (P<0.0001) and higher in those with diabetes (P=0.002 andP=0.0003 in women and men, respectively). Diabetes was associated with a relatively greater increase in prevalence of MI (PR=3.8 vs 1.9) and CHD (PR=4.6 vs 1.8) in women than in men. Logistic regression analysis indicated that prevalent CHD was significantly related to age, diabetes, hypertension, albuminuria, percent body fat, smoking, high concentrations of plasma insulin, and low concentrations of high-density lipoprotein (HDL)-cholesterol. These findings from the baseline Strong Heart Study examination emphasize the relative importance of diabetes-associated variables as risk factors for CHD among populations with high rates of diabetes.Invited lecture presented during the 6th International Milano Meeting on Diabetes held in Milan on 21–23 March, 1996     

Follow‐ups of the Cardiovascular Risk in Young Finns Study in 2001 and 2007: Levels and 6‐year changes in risk factors

Abstract. Raiko JRH, Viikari JSA, Ilmanen A, Hutri‐Kähönen N, Taittonen L, Jokinen E, Pietikäinen M, Jula A, Loo B.‐M, Marniemi J, Lehtimäki T, Kähönen M, Rönnemaa T, Raitakari OT, Juonala M (University of Turku; University of Tampere and Tampere University Hospital, Tampere; University of Oulu, Oulu; Vaasa Central Hospital, Vaasa; University of Helsinki, Helsinki; and Center of Social and Health Services, Kuopio; Finland). Follow‐ups of the Cardiovascular Risk in Young Finns Study in 2001 and 2007: Levels and 6‐year changes in risk factors. J Intern Med 2010; 267 : 370–384. Objectives. To examine cardiovascular risk factor levels in 2007 and their 6‐year changes between 2001 and 2007 using the data collected in the follow‐ups of the Cardiovascular Risk in Young Finns Study. Design. Population‐based follow‐up study. Subjects. A total of 2204 healthy Finnish adults aged 30–45 years (1210 women; 994 men). Main outcome measures. Levels in 2007 and changes between 2001 and 2007 of lipids, insulin, glucose, blood pressure, smoking, body mass index, alcohol consumption, waist and hip circumferences. Results. The mean serum total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol and triglyceride concentrations in 30‐ to 45‐year‐old adults were 5.05, 3.09, 1.34 and 1.40 mmol L^?1, respectively. Significant changes (P < 0.05) between 2001 and 2007 in 30‐ to 39‐year‐old subjects included a decrease in total cholesterol (?6.6% in men, ?5.8% in women), LDL‐cholesterol (?10.2% and ?11.6%) and an increase in diastolic blood pressure (3.5% and 3.9%). Waist circumference (1.8% and 5.5%) and systolic blood pressure increased in 36–39 year olds (2.3% and 2.3%). HDL‐cholesterol increased in 30‐ to 33‐year‐old women (5.8%) Glucose levels increased in 30‐ to 39‐year‐old women (3.7%) and 36‐ to 39‐year‐old men (3.6%). Smoking prevalence decreased in 36‐ to 39‐year‐old men from 29.8% to 22.2%. Conclusions. The 6‐year changes in total cholesterol, LDL‐cholesterol and HDL‐cholesterol in young Finns were favourable between 2001 and 2007. However, waist circumference, glucose and blood pressure levels increased. Therefore, continuous efforts are still needed in fighting against cardiovascular risk factors.