Systolic blood pressure, diabetes and the risk of cardiovascular diseases in the Asia-Pacific region

OBJECTIVE: To assess the association between systolic blood pressure (SBP) and cardiovascular diseases (CVD) among participants with and without diabetes from cohorts in the Asia-Pacific region. RESEARCH DESIGN AND METHODS: Hazards ratios and 95% confidence intervals (CI) for CVD were calculated from Cox models, stratified by sex and region and adjusted for age using individual participant data from 36 cohort studies. Repeat measurements of SBP were used to adjust for regression dilution bias. RESULTS: During follow-up, 7387 fatal or non-fatal cardiovascular endpoints were recorded among 368 307 participants (6.4% with diabetes). SBP was associated with coronary heart disease (CHD), ischaemic stroke and haemorrhagic stroke in a continuous log-linear fashion among individuals with diabetes, as well as those without diabetes. Overall, each 10 mmHg higher usual SBP was associated with 18% (95% CI: 9-27%) and 23% (19-26%) greater risk for CHD among those with and without diabetes, respectively. The corresponding values for ischaemic stroke were 29% (14-45%) and 43% (37-50%), and for haemorrhagic stroke, 56% (32-83%) and 74% (66-82%). The test for heterogeneity by diabetes status in each of these associations was not significant (P >or= 0.10). CONCLUSIONS: Systolic blood pressure is an important marker of risk of CVD in people with and without diabetes. A given reduction in systolic blood pressure is likely to have a similar relative effect on reducing the risk of a cardiovascular event, regardless of diabetes status.     

Diabetes mellitus and risk of fatal ischaemic heart disease by gender: 18 years follow-up of 74,914 individuals in the HUNT 1 Study.

AIM: To study long-term mortality from ischaemic heart disease (IHD) in subjects with and without diabetes and how the association between diabetes and fatal IHD is influenced by gender and established cardiovascular disease (CVD). METHODS AND RESULTS: In 1984-86, all inhabitants aged 20 years or older in Nord-Tr?ndelag County, Norway were invited to the HUNT Study. A total of 74,914 participated in our study, 2100 of them with prevalent diabetes. During 18 years of follow-up, 19,967 persons died. Among people without diabetes or CVD at baseline, men had twice (HR 2.20, CI 2.00-2.41) the rate of fatal IHD compared with women. With diabetes present, the gender gap was substantially reduced (HR 1.25, CI 0.9-1.72), and if both diabetes and CVD were present, IHD mortality in men and women was identical (HR 1.1, CI 0.79-1.64). Gender specific analyses showed a stronger association of diabetes with IHD mortality in women (HR 2.71, CI 2.33-3.16) compared with men (HR 1.98, CI 1.70-2.30, test for interaction, P < 0.01). CONCLUSION: Diabetes is a stronger predictor for IHD mortality in women than in men, and diabetes attenuates the usual gender gap in IHD mortality. With both diabetes and established CVD present, the gender gap is fully attenuated.     

Cardiovascular disease and outcome of acute stroke: influence of pre-existing cardiac failure

BACKGROUND AND AIMS: Whilst a number of variables, mostly a consequence of a stroke, are known to predict mortality of acute stroke there is limited information on the significance of pre-existing cardiovascular variables on stroke mortality. We have investigated the influence of pre-existing cardiovascular factors in one cohort of stroke patients. METHODS: We studied 295 patients, mean age 74+/-10 (range 34-96) years; 133 males, presenting with acute stroke for pre-existing cardiovascular disease (CVD) defined as hypertension, atrial fibrillation (AF), ischaemic heart disease (IHD) and cardiac failure (CF). In addition, data were collected on epidemiological and neurological variables known to influence stroke mortality. The most significant of the cardiovascular factors was further investigated against all the other cardiovascular groups together and against those without any CVD. Outcome was measured as their influence on acute phase and 3-month mortality. RESULTS: There was no significant difference in 3-month mortality with hypertension (P=0.62) and IHD (P=0.33) but there was a significant higher mortality in patients with AF (P=0.05) and CF (P <0.001). CF was more significant than all other CVD (hypertension+AF+IHD) together without the failure (P<0.001); odds ratio of 4.5 (95% CI 2.28-9.07). Partial correlation coefficient revealed CF to be an independent significant variable to influence stroke mortality when controlled with AF, stroke syndromes, age, incontinence, pyrexia, dysphagia and Glasgow coma score. CONCLUSIONS: Pre-existing CF has an adverse influence on stroke mortality independent of other known factors. Cardiovascular factors without failure do not have such an effect except the marginal effect of AF.     

中国及各省份人群不同肥胖指标心血管疾病负担比较

探讨我国不同地区由肥胖引起的心血管疾病负担的差异。方法 基于中国高血压调查,随机选取30036名35岁以上研究对象进行随访。使用来自CHS的数据计算全国和省的不同肥胖指标的加权患病率,采用Cox回归分析计算不同肥胖指标全国及分省的心血管疾病校正风险比（Hazard ratio, HR）并估算人群归因百分比（Population attributable fractions, PAFs）。结果：研究纳入325552名CHS参与人群和22793名队列研究人群（平均4.56年的随访,其中1109名参与者发生了至少一次心血管事件）。在全国层面,与正常体重（BMI＜24 Kg/m2）相比,在调整了年龄、教育水平、吸烟、饮酒等多种危险因素后,所有肥胖指标均与CVD风险增加有统计学差异。其中,超重和肥胖的HR分别为正常体重指数的1.18倍（95% CI 1.03~1.34）和1.53倍（95% CI 1.29~1.81）,超重人群心血管疾病的PAFs为6.20%（95% CI 6.16%~6.24%）,肥胖7.08%（95% CI 6.99%~7.17%）;腹型肥胖的HR为1.44 （95% CI 1.27-1.62）,PAFs为13.30%（95% CI 13.21%~13.37%）;体脂率的HR为1.25（95% CI 1.10~1.41）,PAFs为8.99%（95% CI 8.94%~9.04%）;内脏脂肪指数的HR为1.43（95% CI 1.23~1.65）,PAFs为5.14%（95% CI 5.07%~5.21%）。对于各省而言,肥胖的PAFs分布北部和西部省份最高,南部和沿海省份最低。体重指数肥胖的PAFs天津最高为13.31%,海南最低为2.37%;腹型肥胖的PAFs天津最高20.78%,海南最低5.38%。结论：我国心血管疾病很大比例可归因于肥胖。腰围指标较其他肥胖指标心血管疾病PAFs更高,我国北方和经济社会地位较低的省份心血管疾病PAFs显著偏高。     

Effects of prehypertension and hypertension subtype on cardiovascular disease in the Asia-Pacific Region

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure defined blood pressure (BP) levels of 120 to 139/80 to 89 mm Hg as prehypertension and those of ≥ 140/90 mm Hg as hypertension. Hypertension can be divided into 3 categories, isolated diastolic (IDH; systolic BP <140 mm Hg and diastolic BP ≥ 90 mmHg), isolated systolic (systolic BP ≥ 140 mm Hg and diastolic BP <90 mmHg), and systolic-diastolic hypertension (systolic BP ≥ 140 mm Hg and diastolic BP ≥ 90 mmHg). Although there is clear evidence that isolated systolic hypertension and systolic-diastolic hypertension increase the risks of future vascular events, there remains uncertainty about the effects of IDH. The objective was to determine the effects of prehypertension and hypertension subtypes (IDH, isolated systolic hypertension, and systolic-diastolic hypertension) on the risks of cardiovascular disease (CVD) in the Asia-Pacific Region. The Asia Pacific Cohort Studies Collaboration is an individual participant data overview of cohort studies in the region. This analysis included a total of 346570 participants from 36 cohort studies. Outcomes were fatal and nonfatal CVD. The relationship between BP categories and CVD was explored using a Cox proportional hazards model adjusted for age, cholesterol, and smoking and stratified by sex and study. Compared with normal BP (<120/80 mmHg), hazard ratios (95% CIs) for CVD were 1.41 (1.31-1.53) for prehypertension, 1.81 (1.61-2.04) for IDH, 2.18 (2.00-2.37) for isolated systolic hypertension, and 3.42 (3.17-3.70) for systolic-diastolic hypertension. Separately significant effects of prehypertension and hypertension subtypes were also observed for coronary heart disease, ischemic stroke, and hemorrhagic stroke. In the Asia-Pacific region, prehypertension and all hypertension subtypes, including IDH, thus clearly predicted increased risks of CVD.     

A comparison of the associations between risk factors and cardiovascular disease in Asia and Australasia.

BACKGROUND: Cardiovascular disease is already the leading cause of death in many Asian populations. Relationships between vascular risk factors and cardiovascular disease may differ in Asian and western populations. Previously, a lack of prospective data has prevented the reliable quantification of such differences, which, if they were shown to exist, would suggest that novel cardiovascular prevention and treatment strategies are required for Asia. DESIGN: An individual participant data meta-analysis of 32 studies from the Asia-Pacific region involving 331 100 subjects (75% from Asia; 25% from the predominantly Caucasian populations of Australia and New Zealand). METHODS: Outcomes were death from coronary heart disease, ischaemic and haemorrhagic stroke. Hazard ratios were estimated from Cox models for systolic blood pressure (SBP), total cholesterol, triglycerides, body mass index, diabetes and current cigarette smoking, stratified by study and sex and adjusted for age, the other risk factors and regression dilution. RESULTS: After an average period of follow-up of 4 years there were 2082 deaths from coronary heart disease, 600 from haemorrhagic stroke and 420 from ischaemic stroke. The direction and strength of the associations between risk factors and cardiovascular outcomes were similar in the two regions, although in two cases there were significant differences. Triglycerides were more strongly associated with coronary heart disease in Australia and New Zealand (P = 0.03), whereas SBP showed a stronger relationship with haemorrhagic stroke in Asia (P = 0.04). CONCLUSIONS: Classical vascular risk factors act similarly in Asian and Caucasian populations; prevention and treatment strategies should thus be similar. Blood pressure reduction should be particularly effective in Asia.     

Association of Hypertension and Diabetes with Ischemic Heart Disease and Stroke Mortality in India: The Million Death Study

Background:The cardiovascular outcomes of hypertension and diabetes in India have never been studied at the national level.Objectives:We conducted a nationally-representative proportional mortality study to measure the associations of hypertension and diabetes with premature mortality due to ischemic heart disease (IHD) and stroke among Indian adults.Methods:We determined causes of death by verbal autopsy from 2001–14 among 2.4 million households. We defined cases as those who died of the study outcomes and controls as those who died of injuries, respiratory causes, or cancer. We used multivariable logistic regression models to compute adjusted odds ratios (OR) measuring the association of hypertension and diabetes with IHD or stroke mortality, population-attributable fractions (PAF), and time trends.Results:The mean age at death was 55.6 (standard deviation 9.9) years for IHD, 58.2 (9.0) years for stroke, and 46.8 (injury) to 59.8 (respiratory) years for controls. There were more men among both the cases (IHD: 70.1%; stroke: 59.0%) and controls (injury: 76.6%; cancer: 55.4%; respiratory: 59.8%). Hypertension was associated with six- to eight-fold increases in the odds of IHD (OR 5.9, 99% CI 5.6–6.2) and stroke mortality (7.9, 7.4–8.5). Diabetes was associated with double the odds (1.9, 1.7–2.0) of IHD mortality and increased odds of stroke mortality (1.6, 1.4–1.7). Hypertension accounted for an increasing PAF of IHD mortality and decreasing PAF of stroke mortality. Diabetes was associated with relatively lower PAFs and variable time trends.Conclusions:Hypertension is associated with an unexpectedly high burden of cardiovascular mortality, and contributes to an increasing proportion of IHD deaths and a decreasing proportion of stroke deaths. Better management of hypertension and diabetes is urgently required to reduce premature cardiovascular mortality.     

Cholesterol,diabetes and major cardiovascular diseases in the Asia-Pacific region

Aims/hypothesis The aim of this study was to assess the association between total cholesterol and major cardiovascular diseases among persons with and without diabetes in the Asia-Pacific region. Methods We used data on individual participants in 30 cohort studies from the Asia-Pacific region to compute the hazards ratios and 95% CIs for participants with and without diabetes at baseline, using Cox proportional models. Analyses were stratified by sex and region (Asia vs Australia or New Zealand) and adjusted for age. Repeat measurements of total cholesterol were used to adjust for regression dilution bias. Results The analysis included 333,533 individuals (6.3% with diabetes at baseline) who experienced 6,074 fatal and non-fatal cardiovascular events over a median follow-up period of 4.0 years. Total cholesterol was positively associated with coronary heart disease (CHD) and ischaemic stroke, and negatively with haemorrhagic stroke in a continuous, log-linear fashion, similarly among participants with and without diabetes. Each 1 mmol/l increase above the ‘usual’ level for total cholesterol was associated with a 41% (95% CI 23–63%) and 42% (95% CI 35–50%) greater risk of CHD among participants with and without diabetes. The corresponding values for ischaemic stroke were 23% (95% CI 0–52%) and 31% (95% CI 20–44%), respectively. These results were broadly consistent for sex, age and region. Conclusions/interpretation Total cholesterol is associated with similarly increased risks of cardiovascular events in people with and without diabetes. While abnormal levels of other lipid fractions are frequently observed in people with diabetes, these data support aggressive lowering of total cholesterol and LDL-cholesterol levels for prevention of cardiovascular events. Electronic supplementary material The online version of this article (doi:) contains details of all members of the Asia Pacific Cohort Studies Collaboration, which are available to authorised users. Writing committee: A. P. Kengne, A. Patel, F. Barzi, K. Jamrozik, T. H. Lam, H. Ueshima, T. Ohkubo, X. H. Fang, H. C. Kim, M. Woodward.     

Blood pressure and risk of cardiovascular diseases in type 2 diabetes: further findings from the Swedish National Diabetes Register (NDR-BP II)

OBJECTIVES:: Estimate risks of coronary heart disease (CHD), stroke and cardiovascular disease (CVD) with updated mean systolic (SBP) and diastolic (DBP) blood pressure in an observational study of patients with type 2 diabetes. METHODS:: Thirty-five thousand and forty-one patients treated with antihypertensive drugs, and 18?512 untreated patients, aged 30-75 years, without previous heart failure, followed for 6 years until 2009. RESULTS:: In treated patients, nonlinear splines for 6-year risk of fatal/nonfatal CHD, stroke and CVD by BP as a continuous variable showed a progressive increase with higher SBP from 140?mmHg and higher, and with DBP from 80?mmHg, with a J-shaped risk curve at lowest SBP levels, but not obviously at lowest DBP levels. Analysing intervals of SBP with 130-134?mmHg as reference at Cox regression, adjusted hazard ratios (HR) for fatal/nonfatal CHD, stroke and CVD with at least 140?mmHg were 1.22 [95% confidence interval (CI): 1.08-1.39], 1.43 (1.18-1.72), 1.26 (1.13-1.41), all P?相似文献   

Serum selenium concentration and risk of ischaemic heart disease in a prospective cohort study of 3000 males.

Whether an association, causative or not, exists between the level of serum selenium and the risk of ischaemic heart disease (IHD) remains unsettled. We investigated the issue in a cohort of 3387 males aged 53-74 years (mean 63). Based on information about health status, life-style and socioeconomic factors given in a prefilled comprehensive questionnaire, the men were interviewed and the information validated. Following the interview, they underwent a clinical examination and had a venous blood sample drawn for the determination of a number of biochemical characteristics. Three hundred and forty-six men were excluded due to prevalent cardiovascular disease, including stroke. During the next three years (1986-1989) 107 men (approximately 3%) suffered an IHD event; 25 events were fatal. Compared to others, men with serum selenium levels less than or equal to 1 mumol/l, approximately the lowest tertile, had a 70% increased risk of IHD, relative risk (RR) with 95% confidence limits was 1.70 (1.14-2.53). After multivariate adjustment for cholesterol, social class, smoking and age, RR was 1.55 (1.00-2.39). Serum selenium level was significantly (P less than 0.05), but not strongly, correlated with a number of IHD risk factors: serum cotinine, tobacco smoking, social class, alcohol consumption, total cholesterol, hypertension, age and physical inactivity. Body mass index, HDL-cholesterol and triglycerides were not significantly associated with serum selenium. We conclude that middle-aged and elderly Danish men with serum selenium less than or equal to 1 mumol/l had a significantly increased risk of ischaemic heart disease. This association was not explained by the interrelationship of serum selenium and major cardiovascular risk factors.     

Latent ischaemic heart disease among the male employees of an industrial enterprise

Among 3758 men aged 40-50 years--employees of an industrial enterprise, 291 cases of suspected myocardial ischaemia (7.7%) were detected by means of resting ECG. Further 311 cases (8.3%) of latent ischaemic heart disease (IHD) were detected using a standard cardiovascular questionnaire, and 47 other men were positive both on resting ECG (ischaemic changes) and on the questionnaire. Latent IHD was equally frequent among blue and white collar workers. Ischaemic ECG findings were positively associated with a positive questionnaire, presence of hypertension, and hypertension or stroke in family history, and inversely with the alcohol consumption. No relation was found between ischaemic ECG and smoking, hypercholesterolaemia, obesity, education, and physical activity at work or during leisure time. Positive questionnaire data correlated with hypercholesterolaemia; unexpectedly this correlation was closer among non-smokers and moderate smokers than among heavy smokers.     

Risk Factor Clusters and Cardiovascular Disease in High-Risk Patients: The UCC-SMART Study

Background:Clustering of vascular risk factors, i.e., the co-existence of two or more risk factors, has been associated with a higher risk of cardiovascular disease (CVD) in the general population. This study aims to firstly, examine patterns of clustering of major cardiovascular risk factors in high-risk patients and their relation with the risk of recurrent cardiovascular disease and all-cause mortality. Secondly, to assess which combinations are associated with the highest risk of CVD and all-cause mortality and to study population attributable fractions.Methods:A total of 12,616 patients from the Utrecht Cardiovascular Cohort – Second Manifestations of ARTerial diseases (UCC-SMART) study consisting of patients with or a high risk to develop cardiovascular disease were studied. We constructed sixteen clusters based on four individual modifiable risk factors (hypertension, dyslipidemia, current smoking, overweight). Patients were followed from September 1997 to March 2017. Cox proportional hazard models were used to compute adjusted hazard ratios for CVD risk and all-cause mortality and 95% confidence intervals for clusters, with patients without any risk factor as reference group. The population attributable fractions (PAFs) were calculated. Subgroup analyses were conducted by age and sex.Results:During a mean follow-up period of 8.0 years, 1836 CVD events were registered. The prevalence of patients with zero, one, two, three, and four risk factors was 1.4, 11.4, 32.0, 44.8 and 10.4%. The corresponding hazard ratios (HR) for CVD risk and all-cause mortality were 1.65 (95% CI 0.77; 3.54) for one risk factor, 2.61 (1.24; 5.50) for two, 3.25 (1.55; 6.84) for three, and 3.74 (1.77; 7.93) for four risk factors, with patients without any risk factor as reference group. The PAFs were 6.9, 34.0, 50.1 and 22.2%, respectively. The smoking-hypertension-dyslipidemia combination was associated with the highest HR: 4.06 (1.91; 8.63) and the hypertension-dyslipidemia combination with the highest PAF: 37.1%.Conclusion:Clusters including smoking and hypertension contributed to the highest risk of CVD and all-cause mortality. This study confirms that risk factor clustering is common among patients at high-risk for CVD and is associated with an increased risk of CVD and all-cause mortality.     

The combined influence of leisure-time physical activity and weekly alcohol intake on fatal ischaemic heart disease and all-cause mortality.

AIMS: To determine the combined influence of leisure-time physical activity and weekly alcohol intake on the risk of subsequent fatal ischaemic heart disease (IHD) and all-cause mortality. METHODS AND RESULTS: Prospective cohort study of 11 914 Danes aged 20 years or older and without pre-existing IHD. During approximately 20 years of follow-up, 1242 cases of fatal IHD occurred and 5901 died from all causes. Within both genders, being physically active was associated with lower hazard ratios (HR) of both fatal IHD and all-cause mortality than being physically inactive. Further, weekly alcohol intake was inversely associated with fatal IHD and had a U-shaped association with all-cause mortality. Within level of physical activity, non-drinkers had the highest HR of fatal IHD, whereas both non-drinkers and heavy drinkers had the highest HR of all-cause mortality. Further, the physically inactive had the highest HR of both fatal IHD and all-cause mortality within each category of weekly alcohol intake. Thus, the HR of both fatal IHD and all-cause mortality were low among the physically active who had a moderate alcohol intake. Conclusion Leisure-time physical activity and a moderate weekly alcohol intake are both important to lower the risk of fatal IHD and all-cause mortality.     

Complement C3 and C4 in plasma and incidence of myocardial infarction and stroke: a population-based cohort study.

BACKGROUND: Complement factor C3 and C4 have been associated with atherosclerosis and cardiovascular risk factors. This study explored whether plasma levels of C3 and C4 are risk factors for the incidence of cardiovascular disease (CVD). DESIGN: A population-based prospective study of 5850 initially healthy men, 28-61 years old at baseline. METHODS: Plasma levels of C3 and C4 were analysed at the baseline examination. The incidence of coronary events (i.e. fatal or non-fatal myocardial infarction), ischaemic stroke and cardiovascular events (i.e. myocardial infarction, ischaemic stroke or cardiovascular death) was studied over 18 years of follow-up. RESULTS: Adjusted for age, C3 in the fourth quartile (versus the first quartile) was associated with an increased incidence of coronary events [relative risk (RR) 1.54, 95% confidence interval (CI) 1.2-1.9], cardiovascular events (RR 1.56, 95% CI 1.3-1.9), and non-significantly with the incidence of ischaemic stroke (RR 1.31, 95% CI 0.89-1.8). However, after adjustments for smoking, body mass index (BMI), cholesterol, diabetes and systolic blood pressure, these relationships were completely attenuated and non-significant. The relationships were similar for C4 concentrations within the normal range. However, for men with C4 in the top 10% of the distribution (>0.34 g/l), a significantly increased incidence of coronary events was found, which persisted after adjustments for risk factors. CONCLUSION: C3 and C4 show substantial correlations with cardiovascular risk factors, including blood pressure, BMI, and lipids. This relationship accounts for the increased incidence of CVD in men with high C3 levels. However, very high C4 levels may be associated with the incidence of CVD, independently of traditional cardiovascular risk factors.     

Prevalence of diabetes and/or ischaemic heart disease in classes of increasing carotid artery atherosclerosis: an ultrasonographic study.

AIMS: To evaluate the prevalence of non-diabetic subjects and diabetic patients, with or without ischaemic heart disease (IHD), in different classes of increasing carotid atherosclerotic damage. METHODS: Using high-resolution B-mode ultrasound, we studied 598 subjects without known cardiovascular disease (CVD) or diabetes, 74 diabetic patients without CVD, 74 non-diabetic subjects with IHD and 36 patients with both diabetes and IHD. Carotid atherosclerosis was classified as: normal; thickened intima-media; non-stenotic plaque; stenotic plaque. RESULTS: Compared with subjects without diabetes or CVD, the frequency of patients with diabetes without known CVD increased significantly from 'normal' to 'stenotic plaque' (4.1%, 6.4%, 13%, 14.8% for normal, thickened intima-media, non-stenotic plaque and stenotic plaque, respectively; P = 0.0057). The same figures were 6%, 7.6%, 10.2%, 23.3% (P = 0.0007) for non-diabetic subjects with IHD, and 0%, 2%, 5.6%, 15.9% (P < 0.0001) for diabetic patients with IHD. No difference was found comparing subjects with diabetes without CVD with non-diabetic patients with IHD (P = 0.56). Using polychotomous logistic regression analysis, diabetic patients without CVD and non-diabetic subjects with IHD showed a similar association with the increasing degree of carotid atherosclerosis (P = 0.59), but significantly stronger compared with subjects without diabetes or CVD (P < 0.03 for both). CONCLUSIONS: Diabetic patients without known CVD show an advanced degree of carotid atherosclerotic damage similar to non-diabetic subjects with IHD and significantly higher compared with non-diabetic subjects without CVD. Our data support the need for an aggressive early prevention of CVD in diabetic subjects.     

老年2型糖尿病患者合并心脑血管疾病的危险因素分析

目的　探讨老年 2型糖尿病 (diabetesmellitus ,DM)患者心脑血管病变的特点及相关危险因素。方法　通过回顾性分析方法 ,将 2 12例老年 2型DM患者分为心脑血管病变组 (病变组 )和无血管病变组 (无病变组 )各 10 6例。病变组含缺血性心脏病 (ischemicheartdisease ,IHD)患者组 72例和 (或 )脑血管病变 (cerebrovasculardisease,CVD)患者 5 0例。其中 ,两者并存者 16例。对两组间患者的临床数据进行比较及回归分析。结果　病变组的年龄、高血压患病比率、DM病程、尿微量白蛋白排泄率异常比无病变组明显增高 ;各亚组与无病变组的比较也有相似的趋势。回归分析显示 ,年龄、高血压是老年 2型DM患者总的心脑血管病变的独立危险因素 ,同时也分别是IHD和CVD的独立危险因素 ;另外 ,高甘油三酯血症与病变组和IHD分别独立相关 ;吸烟史是IHD的独立危险因素。结论　对于老年2型DM患者 ,除了年龄、高血压外 ,高甘油三酯血症是心脑血管病变的独立危险因子     

Relationships between lipoprotein components and risk of ischaemic and haemorrhagic stroke in the Apolipoprotein MOrtality RISk study (AMORIS)

Objectives. To compare lipoprotein components associated with ischaemic and haemorrhagic stroke by age and gender in the Apolipoprotein MOrtality RISk (AMORIS) Study (n = 148 600). Design. Prospective follow‐up study (11.8, range 7–17 years) of fatal and nonfatal ischaemic and haemorrhagic stroke through linkage with Swedish hospital discharge and mortality registers. Setting. Measurements of lipoprotein components from health check‐ups in the larger Stockholm area. Results. Ischaemic stroke was more common than haemorrhagic stroke (5 :1), but case fatality was higher in haemorrhagic stroke. An elevated apoB/apoA‐1 ratio and triglycerides, non‐HDL cholesterol, low HDL cholesterol, and the total cholesterol to high‐density cholesterol (TC/HDL‐C) ratio were associated with increased incidence of nonfatal and fatal ischaemic stroke as well as all cerebrovascular events (n = 7480) in both genders. The associations were somewhat stronger for nonfatal than fatal events. In ischaemic stroke the apoB/apoA‐1 ratio was a stronger predictor than the TC/HDL‐C ratio in all subjects, in those below 65 years of age and in those with LDL‐C below 3 mmol L^?1. Haemorrhagic stroke was not associated with elevated atherogenic lipoproteins except for increased risk of fatal haemorrhagic stroke in women with a high apoB/apoA‐I ratio. Conclusions. Dyslipidaemia is associated with an increased risk of ischaemic stroke but few relations were seen in haemorrhagic stroke. Use of the apoB/apoA‐I ratio as a marker of dyslipidaemia is at least as efficient as conventional lipids, for the identification of subjects at increased risk of stroke, especially ischaemic stroke. Practical advantages, fasting is not needed, speak in favour of using apoB and apoA‐1 in stroke risk prediction.     

The relationship between higher blood pressure and ischaemic, haemorrhagic stroke among Chinese and Caucasians: meta-analysis.

BACKGROUND AND PURPOSE: Previous studies have suggested that blood pressure is a particularly important risk factor for stroke in Chinese, and that the magnitude of the effect may be greater than in Caucasians. We performed a meta-analysis in order to define the magnitude of the risk of stroke associated with hypertension among Chinese, and to compare the magnitude of this risk with Caucasians. METHODS: We searched Medline from 1966 to 2004, plus Chinese Medical Literature databases from 1977 to 2003 for Caucasian and Chinese studies. Results were pooled using the random effects model, and heterogeneity and publication bias were checked. RESULTS: For a 10 mmHg increase in systolic blood pressure, the pooled risk ratio was 1.44 [95% confidence interval (CI)] 1.39-1.51 for ischaemic stroke, and 1.5 (95% CI 1.45-1.57) for haemorrhagic stroke in Chinese, versus 1.19 (95% CI 1.15-1.23) for total stroke in Caucasians. The pooled odds ratio for hypertension measured dichotomously (defined as > or =160/95 mmHg) was 5.8 (95% CI 4.7-7.2) among Chinese versus 1.93 (95% CI 1.7-2.2) among Caucasians for ischaemic stroke; and 7.2 (95% CI 5.3-9.7) in Chinese versus 3.1 (95% CI 2.5-3.9) in Caucasians for haemorrhagic stroke. CONCLUSION: The risk of stroke associated with hypertension is consistently and significantly greater in Chinese than Caucasians. This may help genetic epidemiologists to dissect the cause of stroke, and emphasizes the particular importance of hypertension control in the Chinese population.     

Walking for prevention of cardiovascular disease in men and women: a systematic review of observational studies

In this systematic review, walking (a generally accessible activity for a largely sedentary population) was assessed as a preventive risk factor for development of fatal and non-fatal cardiovascular disease (CVD). PubMed, CINHAL and reference list searches identified 21 peer-reviewed publications examining walking in relation to CVD; studies assessing active transportation were excluded. Generally, there were dose-dependent reductions in CVD risk with higher walking duration, distance, energy expenditure and pace. Associations appeared to be stronger for ischaemic stroke than other CVD outcomes such as coronary heart disease or haemorrhagic stroke. Adjustment for clinical CVD risk factors, obesity or other types of physical activity generally attenuated but did not eliminate associations. Because functional status may be an important determinant of walking behaviour in adults, potential bias due to pre-existing illness is of concern in all studies reviewed, particularly in case–control studies which ascertain walking retrospectively and yielded the strongest associations. Study findings were consistent with current physical activity recommendations, but there is a need for improvements in measurement of walking and other CVD risk factors, more thorough control for pre-existing illness, examination of mediating or moderating conditions such as obesity and other analytical issues.