Allium vegetable intake and risk of acute myocardial infarction in Italy

Background  Interest in potential benefits of allium vegetables has its origin in antiquity, but the details of these benefits are still open to discussion. Only two epidemiological studies considered the relation between dietary intake of allium vegetables and cardiovascular diseases. Aim of the study  To provide further information we analysed the relationship between onion and garlic intake and acute myocardial infarction (AMI). Methods  We used data from a case–control study of 760 patients with a first episode of non-fatal AMI and 682 controls admitted to the same hospitals. Information was collected by trained interviewers using a validated and reproducible food-frequency questionnaire. Multivariate odds ratios (ORs) and 95% confidence intervals (CIs) were obtained after allowance for recognized confounding factors. Results  Compared with non-users, the ORs of AMI for subsequent categories of onion intake were 0.90 (95% CI: 0.69–1.21) for <1 portion of onion per week and 0.78 (95% CI: 0.56–0.99) for ≥1 portion per week. For garlic, the ORs were 0.84 (95% CI: 0.66–1.09) for intermediate and 0.94 (95% CI: 0.68–1.32) for high use, compared with no or low use. Conclusion  The current study, the first from Mediterranean countries, suggests that a diet rich in onions may have a favourable effect on the risk of AMI.     

Smokers and non-smokers: differences in alcohol consumption and intake of other health-related substances in Norway: A general population study

Background: This study addresses the problem of clustering ofrisky habits, i.e. the drinking and substance use habits ofsmokers and non-smokers. Methods: A sample survey of the generalnon-hospitalized, Norwegian population (>15 years), excludingabstainers from alcohol was used. We investigated differencesin yearly consumption of beer, wine, liquor and total alcoholconsumption and intake of sedatives, snuff, coffee and tea fora sample of daily smokers (n=763) and non-smokers (n=938) (meanage 38.7 years and SD 16.2 years). Results: Compared to non-smokers,male daily smokers drank significantly more beer, wine and liquorthan non-smokers and used snuff more frequently than non-smokers.Female daily smokers drank more beer than non-smokers, but therewere no significant differences for wine and liquor. For bothgenders, the total yearly intake of alcohol was approximatelytwice as high for daily smokers compared to non-smokers. Dailysmokers also used marihuana more frequently and they drank significantlymore coffee but less tea than non-smokers. There were no significantdifferences in use of sedatives. Conclusion: Increased drinkingand several risky health habits are linked to daily smoking.Smoking cessation should be tried out as a preventive strategyfor alcohol consumption as well.     

Beta-carotene intake and risk of nonfatal acute myocardial infarction in women

There are indications that beta-carotene, but not pre-formed vitamin A, is protective on the risk of acute myocardial infarction (AMI). The relationship between nonfatal AMI and the intake of beta-carotene and retinol was investigated in a case-control study conducted between 1983 and 1992 in northern Italy on 433 women with nonfatal AMI and 869 controls in hospital for acute, non-cardiovascular, non-neoplastic, non-digestive, non-hormone related conditions. Odds ratios (OR), with their 95% confidence intervals (CI), were computed by unconditional multiple logistic regression analysis, including terms for age, education, body mass index, smoking, alcohol and coffee drinking, menopausal status, hormone replacement therapy and history of diabetes, hypertension and hyperlipidemia. The risk of AMI was inversely related to beta-carotene intake, with an OR of 0.5 (95% CI: 0.3 to 0.8) for the highest quintile of intake compared to the lowest (² trend = 10.53, p < 0.01). Retinol intake was not associated with AMI, with an OR of 0.9 (95% CI: 0.6 to 1.3) for the highest quintile of intake compared to the lowest. Analysis in separate strata of covariates indicated that the inverse association of beta-carotene intake with risk of AMI was appreciably stronger in younger, lean women with no history of diabetes or hypertension, and in current smokers. The results of this study indicate that the risk of nonfatal AMI in women is inversely related to intake of beta-carotene containing foods, but not foods containing retinol.     

Return to work after first myocardial infarction in 1991-1996 in Finland

BACKGROUND: A substantial number of myocardial infarctions (MI) occur at working age. It is, however, insufficiently well known how many of these patients return to work after their MI. METHODS: Sources of information were the Hospital Discharge Register, the Causes of Death Register and the registers for social security benefits. Availability for the labour market was used as the return to work criterion. Altogether 10,244 persons (8,733 men, 1,511 women) aged 35-59 years had their first MI or coronary death during 1991-1994 in Finland. Persons who survived for 28 days and were not on pension at the time of MI were included in a two-year follow-up. RESULTS: Twenty-nine per cent of patients were already pensioned at the time of their first MI. Of the patients not pensioned at the time of their MI, 4,929 were alive two years after the event. Of them, 38% of men and 40% of women received disability pension, 3% of both genders were on sick leave and 1% of both genders were on unemployment pension. The remainder, 58% of men and 56% of women, did not receive any of these benefits, thus, being available to the labour force. CONCLUSIONS: Nearly one-third of persons having their first MI at working age were already out of the labour force at the time of their MI. Of those who were not pensioned and who survived the event, slightly more than half were available to the labour market two years later.     

绝经期前、后女性急性心肌梗死患者临床特点及危险因素

目的:探讨绝经期前、后女性急性心肌梗死(acutem yocardial infarction,AMI)患者的危险因素、发病特点、预后。方法:2007年1月～2011年1月北华大学附属医院收治的女性AMI患者310例,依据是否绝经及绝经年限分组并对危险因素、临床表现、并发症和入院30天病死率进行比较。结果:绝经前女性AMI患者与绝经后患者相比,高脂血症的发生率更低(OR=8.151,P=0.005);典型胸痛症状的发生与年龄(OR=0.881,P=0.001)及绝经年限(OR=2.600,P=0.025)差异有统计学意义;绝经年限与严重心律失常和心力衰竭(>KillipⅡ级)差异无统计学意义(P>0.05)。合并糖尿病和心力衰竭(>KillipⅡ级)是预测绝经后女性心肌梗死患者死亡率的独立危险因素(OR=1.081,P=0.043;OR=12.339,P<0.001)。结论:绝经期前、后女性心肌梗死患者具有不同的临床特点,应结合其临床特点,采取不同的预防和诊疗措施。     

心肌梗塞患者住院医疗费用及其影响因素分析

目的分析心肌梗塞患者住院医疗费用构成及其主要影响因素,提出针对性的对策和措施,为合理控制医疗费用提供参考依据。方法收集天津市2004年1月-2007年12月确诊的心肌梗塞患者共1 602例,分析其费用构成,采用多元线性回归筛选住院费用的影响因素。结果天津市2004-2007年心肌梗塞患者人均住院费用为24 428.82元;心肌梗塞患者药品费、检查费、治疗费、手术费、床位费、医用材料费、输全血费、成分输血费和其他费用分别为5 726.42元(23.44%)、2 279.89元(9.33%)、3 017.60元(12.35%)、396.66元(1.62%)、480.37元(1.97%)、12 389.22元(50.72%)、29.33元(0.12%)、76.32元(0.31%)和33.00元(0.14%);多元线性回归分析结果表明,手术与否、医院等级、人员类别、住院次数、住院天数、年龄是住院费用的影响因素(P<0.05)。结论合理减少心肌梗塞病人的住院天数,控制医用材料、药品费用的不合理增长,是降低心肌梗塞患者住院费用的有效措施。     

Individual, group and community risk and protective factors for alcohol and drug use among Swedish adolescents

BACKGROUND: A number of factors have been identified that protect adolescents or, alternatively, put them at risk for drug use and other high-risk behaviours. These factors concern different personal and environmental factors, e.g. the community, the school setting, family, peer group and individual characteristics.The aim of the present study was to examine the associations between risk and protective factors and adolescents' use of alcohol and drugs. METHODS: In both May 2003 and 2004, random samples of 4800 adolescents (a total of 9600) in Sweden were contacted and asked to fill out a questionnaire.It concerned use of alcohol and illicit drugs and a large number of adolescent risk and protective factors. A total of 5445 (57%) adolescents agreed to participate. RESULTS: About 44% of the adolescents in grade 9 (15-16 years of age) had been drunk on at least one occasion and nearly 80% of those in grade 11 (17-18 years of age). Almost 15% in grade 9 and 40% in grade 11 had been drinking heavily during the previous month, and 4% in grade 9 and 12% in grade 11 had used cannabis. Strong associations were found between elevated individual, family, school and community risk factors and use of alcohol and drugs. Conversely, protective factors were negatively related to the use of alcohol and drugs. CONCLUSIONS: This study confirms the importance of risk and protective factors within different domains in explaining alcohol and drug use among adolescents. The results support efforts targeting multiple risk and protective factors in alcohol and drug preventive interventions for adolescents.     

Ovarian function and disease risk

The role of ovarian function is reviewed with reference to breast,female genital tract neoplasms, and ischaemic heart disease.The risk of breast cancer is increased by early menarche, latemenopause and regular menstrual cycles. The associations observedare modest, but are still consistent with an unfavourable effectof ovarian function on breast cancer risk. Ovarian cancer ispossibly related to early menarche and associated with latemenopause. A protective effect has been observed with irregularmenstrual cycles and oral contraceptive use. Ovulation has beenrelated to ovarian cancer risk in terms of the multistage modelof carcinogenesis, although the biological process appears morecomplex. Endometrial cancer risk is increased by early menarche,late menopause, nulliparity, and – in premenopausal women– obesity. The risk of endometrial cancer is increasedby oestrogens and decreased by progestins. Thus, anovulationincreases endometrial cancer risk. Ischaemic heart disease isnot related to age at menarche, but is associated with earlymenopause. Irregular menstrual cycles may also inaease the risk.The impact of ovulation on cardiovascular disease should beviewed with reference to the different role of oestrogens (protective)and progestins (possible adverse). Other hormone imbalances(e.g., hyperandrogenaemia) may also be related to ischaemicheart diseases.     

Dietary intake of some food items in smokers and non-smokers in a Mediterranean population

Smokers in several northern European countries and in the USAreportedly consume a less healthy diet than non-smokers. Littleis known of the dietary habits of smokers in Mediterranean countries.The purpose of this study was to assess the diet-smoking relationshipin a sample of Spanish employees. Four worksites were selected.The participation rate was 91.9% of a total number of 1,555employees (1,193 men and 362 women) enrolled In the study. Eachemployee completed a self-administered food-frequency questionnaireand another questionnaire that recorded several cardiovascularrisk factors including their smoking habits. Four occupationalphysicians recorded each subject's weight, height and alcoholconsumption. High intakes of specifically targeted food itemswere used as the dependent variables. Crude and Mantel-Haenszelstratified odds ratios were computed for light (1–19 cigarettes/day)and heavy (>20 cigarettes/day) smokers. Multiple logisticregression models were fitted, controlling for age, sex, bodymass index and alcohol consumption. Heavy smokers were morelikely to have a higher intake of eggs, whole milk, pork, friedfoods and legumes. Light smokers were less likely to have ahigher intake of fruit than non-smokers. Unhealthy eating patternsand smoking are highly associated. Heavy smokers showed a lesshealthy dietary profile than both light smokers and non-smokers.Dietary recommendations should be included in the health promotioninformation addressed to smokers in Mediterranean countries.     

Place, time and certified cause of death in people who die after hospital admission for myocardial infarction or stroke

BACKGROUND: Two areas of uncertainty about routine statistics for mortality after hospital admission for myocardial infarction (MI) or stroke are i) whether most deaths occur in the admission episode itself rather than after discharge, and ii) whether most deaths are certified on death certificates as, respectively, MI or stroke. METHODS: Use of linked hospital and mortality statistics to analyse the time, place and certified cause of death in people aged 35-74 after admission for MI or stroke. RESULTS: Of 7,964 deaths within a year of admission for MI, 5,686 (71.4%) occurred within 30 days of admission. Of these, 4,856 (85.4%) occurred during the initial hospital admission. Of 7,070 deaths within a year of admission for stroke, 4,905 (69.4%) were within 30 days, and 4,509 (91.9%) of these occurred during the initial admission. As expected, deaths at longer intervals than 30 days occurred mainly after discharge. Of deaths within 30 days of MI and stroke, 85.2% and 80.0%, respectively, were certified with MI or stroke as the underlying cause of death. CONCLUSION: In-hospital death rates alone, calculated without record linkage to death certificates, would have identified most deaths that occurred within 30 days of admission. Nonetheless, linkage added to completeness of ascertainment even within this time period. Data without linkage are unreliable in identifying deaths at longer time intervals. Routine mortality statistics for MI and stroke, as the underlying cause, reliably included most deaths that occurred within 30 days of admission for each respective disease.     

Cigarette smoking, alcohol consumption, and serum lipid profile among medical students in Greece

BACKGROUND: The lack of data regarding health habits of medical students in Greece prompted a cross-sectional study to assess tobacco use, alcohol consumption and serum lipoprotein levels among students in the University of Crete School of Medicine. METHODS: A self-administered questionnaire on smoking and alcohol consumption was distributed to third-year medical students for twelve consecutive years (1989-2000). A total of 849 students (462 males, 387 females) participated in the survey. Biochemical measurements were taken and multi-variant analysis of the data was performed. RESULTS: The prevalence of smoking among males and females was 33.2% (N = 150) and 28.4% (N = 108), respectively (mean cigarette consumption 13/day). As many as 349 males (77.2%) and 220 females (58.0%) reported consuming alcohol on a regular basis. The prevalence of low HDL-cholesterol (< 0.9 mmol/l) was 14.5% in males and 5.1% in females, and of high LDL-cholesterol levels (> 4.1 mmol/l) in 11.1% of male and 5.5% of female participants. Smoking was related to higher triglyceride (p = 0.032), and lower HDL-cholesterol (p = 0.037) serum levels. Total cholesterol, LDL-cholesterol, and the TC/HDL-cholesterol ratio were strongly related with the level of smoking (p = 0.006, p = 0.008, and p = 0.006 respectively). CONCLUSIONS: The results document a high prevalence of smoking among physicians-to-be in Greece. Tobacco use was strongly associated with a lipid profile predisposing to increased risk for cardiovascular disease. Health promotion programmes should therefore be instituted not only during the first years of medical studies, but rather at a much earlier stage in life.     

心肌梗死和脑梗死并存80例临床分析

目的 探讨心肌梗死和脑梗死并存的临床特点。方法 回顾分析80例心、脑梗死并存患者的临床资料。结果两组有某些共同的危险因素。统计脑梗死和急性心肌梗死发病的时间间隔,在2月以内的比例均较高,心、脑梗死组为83.3％,脑、心梗死组为55.3％,尤其以2周之内突出,心、脑梗死组为45.2％,脑、心梗死组为34.2％。心、脑梗死组右室心肌梗死伴发率及左室肥大、室壁瘤的比例均高于脑、心梗死组,而EF值、入院时的舒张压均明显低于脑、心梗死组。两组年龄≥65岁患者住院病死率均明显增高(P<0.05)。结论 老年(≥65岁)可能是心、脑梗死和脑、心梗死预后危险因素,心肌梗死和脑梗死时应积极防治并发症,争取获得最好的转归。     

The incidence of hypertension and the effects of a regular high-dose alcohol intake on blood pressure in a medium-sized Hungarian town (Csongrad)

Hypertension screening was carried out on 13,772 adults (74%of the eligible population) in conjunction with X-ray screeningfor tuberculosis in the Hungarian town of Csongrád. Inyoung adults, the blood pressure was found to be higher amongstmen, whilst in older subjects the women had higher blood pressures.Systolic hypertension was detected in one-third of the populationand diastolic hypertension in one-sixth. Of the hypertensivecases detected, 34% were unaware of their disease. Among others,the effects of alcohol intake on blood pressure were investigated.There were 21.4% of the men and 2.3% of the women who admittedto being regular alcohol consumers. Direct and significant correlationswere found between the quantity of alcohol consumed and boththe systolic (p<0.001) and diastolic (p<0.05) blood pressures.The prevalence of hypertension (on the basis of the WHO criteria)was higher in heavy (>80 g ethanol/day) drinkers (29.9%)than in abstinent subjects (20.5% p<0.001). When participantswere subdivided according to age groups, only the men providedsufficient data for a statistical analysis. The systolic bloodpressure of heavy drinkers was higher than that of non-drinkers(y =0.664x + 100.2; y = 0.506x + 114.6; p<0.05).     

心肌缺血预适应对急性心肌梗死影响的临床分析

目的 观察心肌缺血预适应对急性心肌梗死(AMI)的保护作用。方法 将80例急性心肌梗死患分为缺血预适应组48例和无缺血预适应组32例，将两组临床资料进行对比分析。结果 缺血预适应组小面积心肌梗死的发生率明显高于无缺血预适应组，而心律失常、心衰、心源性休克、再梗等的发生率及病死率明显低于无缺血预适应组，有统计学意义。结论 心肌缺血预适应对AMI具有保护作用。     

Sex differences in risk factors, treatment and mortality after acute myocardial infarction: an observational study

BACKGROUND: Coronary heart disease is the major cause of death of postmenopausal women in industrialised countries. Although acute myocardial infarction (AMI) affects men in greater numbers, the short-term outcomes for women are worse. In the longer term, studies suggest that mortality risk for women is lower or similar to that of men. However, length of follow up and adjustment for confounding factors have varied and more importantly, the association between treatment and outcomes has not been examined. STUDY OBJECTIVE: To investigate the association between sex differences in risk factors and hospital treatment and mortality after AMI. DESIGN: A prospective observational study collecting demographic and clinical data on cases of AMI admitted to hospitals in Yorkshire. The main outcome measures were mortality status at discharge from hospital and two years later. SETTING: All district and university hospitals accepting emergency admissions in the former Yorkshire National Health Service (NHS) region of northern England. PARTICIPANTS: 3684 consecutive patients with a possible diagnosis of AMI admitted to hospitals in Yorkshire between 1 September and 30 November 1995. MAIN RESULTS: AMI was confirmed by the attending consultant for 2196 admissions (2153 people, 850 women and 1303 men). Women were older and less likely than men to be smokers or have a history of ischaemic heart disease. Crude inhospital mortality was higher for women (30% versus 19% for men, crude odds ratio of death before discharge for women 1.78, 95% confidence intervals 1.46, 2.18, p=0.00). This difference persisted after adjustment for age, risk factors and comorbidities (adjusted OR 1.29, 95% CI 1.04, 1.63, p=0.02), but was not significant when treatment was taken into account. Women were less likely to be given thrombolysis (37% versus 46%, p<0.01) and aspirin (83% versus 90%, p<0.01), discharged with beta blockers (33% versus 47%, p<0.01) and aspirin (82% versus 88% p<0.01) or be scheduled for angiography, exercise testing or revascularisation. Adjustment for age removed much of the disparity in treatment. Crude mortality rate at two years was higher for women (OR 1.81, 95%CI 1.41, 2.31, p=0.00). Age, existing risk factors and acute treatment accounted for most of this difference, with treatment on discharge having little additional influence. CONCLUSIONS: Patients admitted to hospital with AMI should be offered optimal treatment irrespective of age or sex. Women have a worse prognosis after AMI and under-treatment of older people with aspirin and thrombolysis may be contributing to this.     

急性心肌梗死患者近期预后的危险因素分析

目的探讨影响急件心肌梗死患者近期预后的危险因素,为改善急性心肌梗死患者的预后提供科学依据。方法选取2003-2008年山东省菏泽市牡丹区中医院419例急性心肌梗死患者作为研究对象,对相关危险因素进行单因素和多因素Logistic回归分析。结果2003-2008年笔者所在医院共收治419例急性心肌梗死患者,其中抢救无效死亡19例,病死率为4.53％。高龄、心肌梗死面积大、未及时溶栓、糖尿病、高血压、高血脂是影响心肌梗死患者近期预后的主要危险因素,OR值分别为1.462、3.205、2.390、2.401、2.133和1.650。结论影响急性心肌梗死患者近期预后的原因很多,及时给予尿激酶进行溶栓治疗,有效控制患者的血压、血糖和血脂浓度,可以改善急性心肌梗死患者的近期预后,降低病死率。     

School-related risk factors for drunkenness among adolescents: risk factors differ between socio-economic groups

Purpose: To examine, separately for boys and girls, whether socio-economic differences in drunkenness exist in adolescence, whether the level of exposure to school-related risk factors differ between socio-economic groups, and whether the relative contribution of school-related risk factors to drunkenness differ between socio-economic groups. METHODS: The study population was a random sample of 1453 Danish 15-year-old students. The outcome measure was drunkenness 10 times or more, as a lifetime measure. Predictor variables comprised five aspects of well-being at school. Socio-economic position (SEP) was measured by parental occupation. RESULTS: Among girls, exposures to school-related risk factors were more prevalent in lower socio-economic groups. Poor school satisfaction was associated with drunkenness among girls from high SEP, odds ratio (OR) = 2.98 (0.73-12.16). Among boys from high SEP autonomy in decision-making was associated with drunkenness, OR = 2.74 (1.06-7.08), whereas poor school satisfaction was associated with drunkenness among boys from intermediate SEP, OR = 2.26 (0.98-5.22). Weak Parental Support in school-related matters, OR = 3.92 (1.16-13.24), and disliking school, OR = 9.12 (1.77-47.09), were associated with drunkenness among boys from low SEP. These associations were also seen among girls although not significant. CONCLUSION: We found that well-being at school had socially differential impact on drunkenness in adolescence.     

Moderate alcohol intake in pregnancy and the risk of spontaneous abortion

Women attending routine antenatal care at Aarhus University Hospital, Denmark, from 1989 to 1996 were eligible for this cohort study on the association between alcohol intake in pregnancy and the risk of spontaneous abortion. We included 24 679 singleton pregnancies in the study. We used Cox regression analyses with delayed entry for the analyses. We found an increased risk of spontaneous abortion in the first trimester (7-11 completed weeks of gestation) for women consuming > or =5 drinks/week. We found no association between alcohol intake and spontaneous abortion during the second trimester. Common methodological problems in relation to studies on spontaneous abortions are discussed, as are problems with possible under-reporting of alcohol consumption. We conclude that women consuming > or =5 drinks/week are at increased risk of first trimester spontaneous abortion.