Association of overall and abdominal obesity with coronary heart disease risk factors: comparison between urban and rural Indian men

The relationship of body mass index (BMI), conicity index (CI) and waist circumference to four coronary heart disease (CHD) risk factors (systolic and diastolic blood pressures, total cholesterol and high-density lipoprotein (HDL) cholesterol levels) was examined in urban (n = 110) and rural (n = 102) men aged > or = 20 years, drawn from the 'Reddy' population of Southern Andhra Pradesh, India. Using ANCOVA we found significant difference (< 0.01) for systolic blood pressure, total cholesterol and HDL cholesterol between the urban and rural samples. The Pearson's correlation coefficients suggest that BMI and waist circumference had significant relationships with most of the risk factors in both the populations. The CI did not significantly influence any of the risk factors in the urban population; however, in the rural population, CI did show a significant positive relationship with both of the blood pressures and with TC. Even after controlling for age, smoking and physical activity (partial correlations), the relations remained constant. In multiple linear regression, BMI showed significant positive association with systolic and diastolic blood pressures (<0.01) and HDL cholesterol (<0.05) in the rural population only. However, the Cl showed a significant association with HDL cholesterol, and waist circumference with total cholesterol and HDL cholesterol in the rural population. The results of the present study revealed that BMI and waist circumference had a greater influence on the CHD risk factors, and that the influence was more conspicuous in the rural sample. Comparing the association of abdominal obesity measures (CI and waist circumference) with CHD risk factors, waist circumference better correlated with most of the risk factors. Hence the present study suggests that BMI and waist circumference are better indicators of CHD risk factors. However, the importance of Cl has to be further studied in South Asian populations.     

人体测量指标与心血管病危险因素的典型相关分析

为探讨人体测量指标与心血管危险因素指标的相互关系,确定与心血管危险因素相关最密切的人体测量指标,对1274名20～60岁农村居民进行问卷和身高、体重、四围、血胆固醇、甘油三酯、高密度脂蛋白、血糖的测定.计算出体重指数(BMl)、腰臀比(WHR)、腹臀比(AHR)和锥削度指数(CI)后,与血胆固醇、甘油三酯、高密度脂蛋白、血糖作典型相关分析.结果表明人体测量指标与心血管危险因素指标呈典型相关(典型相关系数0.408～0.592);人体测量指标中,体重指数的贡献最大,与心血管因素的相关最密切.结论体重指数是本组人群中最简单但最有价值的人体测量指标.     

Relationship between the pattern of coronary artery disease risk factors and lipid ratios with five groups of body mass index in 28566 healthy adults

Pattern of the coronary artery disease (CAD) risk factors across body mass index (BMI) categories remains uncertain. There is a different threshold of obesity for increasing cardiovascular hazard across populations, accordingly recognition and management of obesity and overweight can guide better control of CAD epidemic in the national level. To determine the discrepancy in the prevalence of CAD risk factors across five BMI categories. A population based survey of 28566 participants recruited to medical screening of taxi drivres in Tehran (MSTDT) was designed. According to a standardized protocol data on CAD risk factors were obtained by taking medical history, examination and laboratory tests. After adjustment for age, sex, literacy, smoking, systolic blood pressure (SBP), fasting blood sugar (FBS), and LDL-C/HDL-C ratio, these CAD risk factors of diastolic blood pressure (DBP)>90 mmHg, hypertriglyceridemia, high triglyceride/ HDL-C ratio, hypercholesterolemia, and high cholesterol/HDL-C ratio were increased significantly across five incremental categories of BMI. Prevalence of DBP> 90 mmHg, hypertriglyceridemia, hyper cholesterolemia and ratios of cholesterol/ HDL-C and TG/HDL-C increased considerably across five groups of BMI. This pattern is different from previous research and our results endorsed more features of pattern of CAD risk factors across BMI categories.     

Use of anthropometric measurements in assessing risk for coronary heart disease: a useful tool in worksite health screening?

The study examined the association between the anthropometric measurements body mass index (BMI), waist/hip ratio (WHR), and waist/thigh ratio (WTR) and cardiovascular risk factors, and assessed whether a combination of BMI and WHR could be used in routine screening of risk for cardiovascular arteriosclerotic disease at worksites. The data were obtained from a cross-sectional survey designed to assess the nutritional situation, with special reference to cardiovascular risk factors. The study population comprised 372 healthy men working on platforms in the North Sea. Serum cholesterol, triglyceride, fibrinogen, and blood pressure were positively related to the anthropometric variables, while high-density lipoprotein (HDL) was inversely related with them. The relations remained after adjusting for possible confounders, such as age, smoking, physical activity, and an indicator of dietary fat intake. In stepwise multiple linear regression models, BMI, WHR, and WTR were positively related to serum cholesterol, triglycerides, fibrinogen, diastolic blood pressure, and systolic blood pressure, and inversely related to HDL. When controlling for the anthropometric variables WHR and WTR, BMI was not independently related to fibrinogen and risk score. WHR and WTR were not independently related to systolic and diastolic blood pressure, and WTR was in addition not related to triglycerides when controlling for BMI. Overall, the anthropometric variables BMI and WHR were considered the best predictors for CAD risk when taking several risk factors into consideration. A joint variable between BMI and WHR, called body score, constituted the four categories lean, lean android, overweight gynoid, and overweight ovoid. This body score was positively associated with levels of serum lipids, fibrinogen, and blood pressure, and inversely associated with HDL. In stepwise multiple linear regression models, controlling for possible confounding variables, body score was positively related to CAD risk. Dividing the risk score into tertiles, about 51% of the lean were in the first, while 46% of the overweight ovoid were in the third tertile. Those classified as lean android or overweight gynoid had about the same distribution, namely between 31% and 39% in each tertile if the two categories were combined. These data support the hypothesis that BMI, WHR, and WTR are independent predictors for risk factors for CAD among oil workers, and that combinations of BMI and WHR are strong enough predictors to be useful in routine screening for CAD risk at worksites. Based on these findings, supported by data from the literature, a matrix aimed at screening for follow-up at worksites is proposed.     

Hypercholesterolemia and its risk factors among schoolchildren

OBJECTIVE: To identify the risk factors of hypercholesterolemia among schoolchildren aged 7 to 10 years, Brazil. METHODS: A case-control study was conducted among 172 children matched by sex and age +/-3 months in Campinas, Brazil. Cases were defined as hypercholesterolemia when cholesterol (3)200 mg/dL and controls when cholesterol 140 and 170 mg/dL. Besides drawing a blood sample for cholesterol, blood pressure, body mass index and family history of cardiovascular diseases were documented. Data were analyzed through bivariate correlation using t-test for quantitative variables and Chi-square for family history of cardiovascular diseases. Odds ratio was used to estimate the risk of hypercholesterolemia. RESULTS: On average, a cholesterol of 215 mg/dL for cases and 154 mg/dL for controls was found. The mean systolic blood pressure was 107 mmHg for cases and 106 mmHg for controls. The mean of diastolic blood pressure was 67 mmHg for cases and 68 mmHg for controls. The mean body mass index was 18.2 kg/m(2) in the case-group and 17.1 kg/m(2) in the control group. Bivariate analysis showed an association between hypercholesterolemia and body mass index (p=0.048). The odds ratio revealed obesity as a risk factor in this study population (OR=2.17; CI=1.05 to 4.45). CONCLUSIONS: The results showed obesity as a risk factor for hypercholesterolemia.     

Prevalence of the methylenetetrahydrofolate reductase 677C > T mutation in the Mediterranean Spanish population. Association with cardiovascular risk factors

Methylenetetrahydrofolate reductase (MT-HFR) is a key enzyme involved in folate metabolism. A common cytosine (C) to a thymine (T) mutation at nucleotide 677 (677C > T) in the MTHFR gene which converts an alanine residue to a valine, has been related with several biochemical phenotypes and with cardiovascular risk, depending on the population studied. Our objective was to estimate the prevalence of the 677C > T mutation in a large and randomly selected sample (289 men and 427 women) from the Mediterranean Spanish population, and to test the association between this genetic variant and some cardiovascular risk factors. For both genders, the prevalence of CC, CT and TT subjects was 32.0, 52.2 and 15.8%, respectively. The frequency (95% confidence interval) of the 677T allele was 0.44 (0.40–0.48) in men and 0.40 (0.37–0.44) in women. This prevalence was significantly different from other European countries, and among the highest reported in the world for any healthy population. We found no association between the 677C > T gene variants and age, body mass index (BMI), total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides or diastolic blood pressure in men and women. However, in men, a statistically significant increase of systolic blood pressure with the number of mutant alleles was found (122.2 mmHg in CC, 125.1 mmHg in CT and 128.5 mmHg in TT subjects; p for trend = 0.030). This association remained significant (p = 0.047) even after adjustment for age, BMI, alcohol consumption, tobacco smoking, education and physical activity.     

A potential inverse association between insulin-like growth factor I and hypertension in a cross-sectional study

PURPOSE: Elevated circulating insulin-like growth factor I (IGF-I) levels increasingly are being implicated as a potential risk factor for the development of some cancers; however, relatively few epidemiologic studies have focused on potential relationships between circulating IGF-I levels and cardiovascular risk factors or cardiovascular disease. Hence, our objective is to examine relationships between IGF-I levels; body mass index (BMI); fasting insulin level; IGF binding protein 1 (IGFBP-1), IGFBP-2, and IGFBP-3 levels; and an array of traditional cardiovascular risk factors. METHODS: Our analysis included 715 men and women aged 30 to 62 years who participated in the V?sterbotten Intervention Project cohort. IGF-I and IGFBP-1, -2, and -3 were measured in stored plasma samples. Cardiovascular risk factors of interest included glucose level (fasting and 2-hour postload), lipid levels (total cholesterol, high-density lipoprotein cholesterol, and triglycerides), blood pressure (systolic and diastolic), and hypertension status. All presented results were adjusted for age, sex, and laboratory batch. RESULTS: IGF-I quartile was associated inversely with 2-hour glucose level and diastolic blood pressure. There was a stepwise inverse graded association between increasing IGF-I quartile and hypertension, with an odds ratio of 0.51 (95% confidence interval, 0.29-0.90) for hypertension comparing the fourth IGF-I quartile with the first. Further adjusting for BMI and IGFBP-3 level simultaneously strengthened the inverse association, with an odds ratio of 0.42 (95% confidence interval, 0.22-0.80) for hypertension comparing the fourth with the first IGF-I quartile. CONCLUSIONS: Contrary to positive associations between IGF-I levels and some cancers, our results suggest that IGF-I level may be related inversely to prevalent hypertension, a risk factor for cardiovascular disease.     

Association of Suboptimal Health Status and Cardiovascular Risk Factors in Urban Chinese Workers

Suboptimal health status (SHS) has become a new public health challenge in urban China. Despite indications that SHS may be associated with progression or development of chronic diseases such as cardiovascular and metabolic diseases, there are few reports on SHS investigations. To explore the relationship between SHS and traditional cardiovascular risk factors, a cross-sectional study was conducted in a sample of 4,881 workers employed in 21 companies in urban Beijing. Blood pressure, glucose, lipid levels (total cholesterol, high-density lipoprotein [HDL] cholesterol, low-density lipoprotein [LDL] cholesterol and triglycerides), cortisol, and body mass index were measured. SHS score was derived from data collection in the SHS questionnaire (SHSQ-25). Univariate analysis and linear two-level model were used to analyze the association of SHS with the cardiovascular risk factors. Serum cortisol level was much higher among the SHS high-score group than that among the low SHS score group (204.31 versus 161.33 ng/ml, P < 0.001). In a linear two-level model, we found correlation between SHS and systolic blood pressure, diastolic blood pressure, plasma glucose, total cholesterol, and HDL cholesterol among men, and correlation between SHS and systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, and HDL cholesterol among women after controlling for age, education background, occupation, smoking, and physical activity. SHS is associated with cardiovascular risk factors and contributes to the development of cardiovascular disease. SHS should be recognized in the health care system, especially in primary care.     

健康体检1084例踝臂指数与心血管危险因素关系的分析

目的了解踝臂指数（ABI）与心血管疾病各相关因素之间的关系。方法对1084例门诊体检人群,检测空腹血糖、血清总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、体重指数、收缩压、舒张压,并计算不同性别、不同ABI分组条件下各组的患病率。结果男性和女性在不同ABI组中的分布不相同（x^2=52．130,P〈0．05）。按ABI分组,心血管各危险因素中年龄、体重指数、收缩压、舒张压、总胆固醇、三酰甘油及空腹血糖在三组中比较,差异有统计学意义（F值分别为28．268、24．826、192．950、88．213、7．602、14．802、199．216,P〈0．05）。其中年龄、血压及空腹血糖随着ABI的减低而逐渐增加。随着ABI分级的增加,同时并存多个危险因素的例数逐渐增加。结论ABI是预测心血管疾病的重要因子,有利于心血管疾病的发现和监控。     

Random errors in the measurement of 10 cardiovascular risk factors

Random errors in the measurement of 10 commonly investigated cardiovascular risk factors (systolic and diastolic blood pressure, blood cholesterol, blood glucose, pulse rate, body mass index (BMI), cigarette consumption, passive smoking, alcohol intake and physical exercise) were assessed in a general population cohort (n = 2517) and a workforce cohort (n = 8008). Random errors were estimated from regression dilution ratios (lower ratios imply greater random error, and a ratio of one implies no random error). All of the risk factors, except for BMI (which had regression dilution ratios of 0.93 and 0.98 in the two cohorts), were measured with substantial levels of random error. Particularly low regression dilution ratios were observed for physical exercise (0.28 and 0.39) and pulse rate (0.47 and 0.56). For each of these risk factors, with the possible exception of BMI, associations with long-term average values could be importantly biased toward the null unless appropriate corrections are made.     

Socio-economic status and risk factors for cardiovascular disease: A multicentre collaborative study in the international clinical epidemiology network (INCLEN)

As part of a multicentre collaborative study of risk factors for cardiovascular disease (CVD) in the International Clinical Epidemiology Network (INCLEN), each of 12 Centres in 7 countries examined the relationship between CVD risk factors and socio-economic variables.

Each Centre (three in Thailand, two each in China, Chile and Brazil and one each in the Philippines, Indonesia and Colombia) examined approx. 200 men aged 35–65 drawn at random from a population within their locality (not designed to be necessarily representative of the general population). Standardized measures of CVD risk factors included body mass index (BMI), blood pressure, blood cholesterol and cigarette smoking habits. Education, occupation and current income were grouped into ordinal categories of socio-economic status according to standard protocol guidelines, and comparisons were made between risk factor levels within each of these categories. Many of these populations had higher levels of education (as a marker of socio-economic status) than would the general population of their country.

For both BMI and blood cholesterol there were a number of centres which showed positive associations with socio-economic status. These were predominately in China or urban or rural South East Asia. For blood pressure and cigarette smoking the associations with socio-economic status tended to be negative, more in line with the direction of association seen in the “Developed” World.

The high risk factor levels found in these populations, particularly the alarming prevalence of cigarette smoking in Asia and the high cholesterol levels in Latin America and Urban S.E. Asia suggest that CVD will emerge as a major public health problem in the Developing World. As this happens, knowledge of the patterns of association between risk and socio-economic status is likely to be important in both understanding the reasons for the patterns of disease and directing efforts at prevention.     

Indicators of fat distribution, serum lipids, and blood pressure in European women born in 1948--the European Fat Distribution Study

In the spring of 1986, the authors studied the relation between body mass index and anthropometric indicators of fat distribution to cardiovascular risk factors (serum lipids and blood pressure) in approximately 450 women aged 38 years randomly selected from population registers in five European centers. Waist circumference was, in univariate analysis, more strongly related to triglycerides (positive association) and high density lipoprotein (HDL) cholesterol (negative association) than to body mass index or any other anthropometric measurement. Among the centers, we observed considerable variation in the strength of the associations between anthropometric measurements and risk factors. After adjustment for body mass index, most associations between skinfolds and circumferences and risk factors were reduced to statistically nonsignificant levels, but in some centers there were independent contributions of circumferences or circumference ratios to serum lipids, but not to blood pressures. Adjustment for differences in body mass index and fat distribution between the centers did not reduce the differences in cardiovascular risk factors between the different centers but instead revealed that serum cholesterol levels were lowest in the centers of southern Europe (Italy) and that HDL cholesterol levels were higher. Blood pressure was highest in the Swedish women. We conclude that in some female populations, but not in others, indicators of fat distribution are related to serum lipids but not to blood pressure, independent of body mass index.     

The association between Type A behavior and change in coronary risk factors among young adults.

The association of Type A/B behavior pattern and changes in blood pressure, total serum cholesterol, serum triglyceride, body mass, and smoking was estimated in a cohort of 375 young Black and White men and women from a rural county in Central Kentucky between 1978-79 and 1985-88. Type A participants experienced significant increases in systolic (2.90 +/- 1.29 mmHg) and diastolic (3.80 +/- 1.17 mmHg) blood pressure and in cigarette smoking (3.26 +/- 0.89 cigarettes per day) over the eight-year follow-up period, but Type B participants experienced no change. Type A and B individuals showed similar changes in total serum cholesterol, serum triglyceride, or body mass. Differences between behavioral types in blood pressure were present for women but not men, and for Blacks but not for Whites. These findings suggest a possible significance of the Type A pattern for the development of cardiovascular risk of young adults.     

Relationship between hyperuricemia and other cardiovascular disease risk factors among adult males in Taiwan

Hyperuricemia is associated with cardiovascular disease risk factors such as obesity, impaired glucose tolerance, hypertension, and hyperlipidemia. However, this relationship between serum uric acid (SUA) concentrations and cardiovascular disease (CVD) is a controversial one, especially among males. The purpose of this study is to evaluate the association between SUA concentrations and other CVD risk factors among adult males in Taiwan. After multi-stage sampling procedures, we randomly selected 1743 Taiwanese males with a mean age of 35 years (from 22 to 54) in this study. Anthropometric, blood pressure and biochemical variables, including serum uric acid, glucose, total cholesterol and triglyceride concentrations, were measured. Among the study population, the mean SUA concentration was 6.5 ± 1.5 mg/dl. There were 290 (16.6%) subjects with SUA concentrations 8.0 mg/dl (defined as hyperuricemia). Compared to normouricemic subjects, hyperuricemic subjects had significantly greater age-adjusted body weight (75.3 vs. 69.2 kg, p < 0.001), body mass index (BMI, 25.5 vs. 23.6 kg/m², p < 0.001), higher blood pressure (BP, 120.2 vs. 115.2 mmHg for systolic BP and 78.5 vs. 75.3 mmHg for diastolic BP, both p < 0.001) and blood lipid concentrations (193.8 vs. 182.1 mg/dl for total cholesterol and 123.7 vs. 94.4 mg/dl for triglycerides, both p < 0.001). SUA concentration was positively correlated with body weight, BMI, BP and serum lipid concentrations (all p < 0.001). In multivariate regression analyses, after adjusting for potential confounders, SUA concentration was significantly positively associated with diastolic BP, serum total cholesterol and triglyceride concentrations. An increase of 1 mg/dl of SUA was associated with a 2.1 mg/dl elevation in serum total cholesterol (p < 0.001) and a 5.4 mg/dl increase in triglyceride (p < 0.001). From this study, we found that hyperuricemia in subjects is associated with being overweight, and having high blood pressure and hyperlipidemia. There is a significantly positive association between SUA concentration and other CVD risk factors among adult males in Taiwan.     

北京地区1359名非糖尿病人群心血管病危险因素与胰岛素抵抗的关系研究

目的 采用横断面研究的方法 分析北京地区非糖尿病人群各心血管病危险因素与胰岛素抵抗的关系.方法 采用分层随机抽样方法 在年龄25～64岁的北京市自然人群中选取1475人,利用该人群中未患糖尿病的1359人资料对各心血管疾病危险因素与胰岛素抵抗关联的密切程度进行分析.分析中采用稳态模式评估法(HOMA)获得的HOMA指数作为胰岛素抵抗程度的评价指标.结果 将HOMA指数取自然对数后进行分析,心血管病危险因素与HOMA指数均存在不同程度的关联(P＜0.001).按关联密切程度由高到低依次为血糖、体重指数(BMI)、甘油三酯(TG)、腰围(WC)、高密度脂蛋白胆固醇(HDL-C)、血清尿酸、DBP、SBP和总胆固醇(TC).在调整了性别和年龄后,血糖(r=0.49)、BMI(r=0.44)、TG(r=0.44)、WC(r=0.41)、HDL-C(r=-0.32)、尿酸(r=0.33)、SBP(r=0.20)、DBP(r=0.18)和TC(r=0.16)依然和HOMA指数存在关联(P＜0.001).将HOMA指数位于人群上四分之一分位者定义为有胰岛素抵抗,多因素logistic回归分析显示性别(OR=1.75)、低HDL-C(OR=1.80)、高尿酸血症(OR=2.11)、高TG(OR=2.14)和腹部肥胖(OR=2.68)与胰岛素抵抗独立相关.结论 心血管病危险因素均与胰岛素抵抗存在不同程度的关联,其中低HDL-C、高TG、腹部肥胖和高尿酸血症与胰岛素抵抗独立相关.     

Trimester-specific blood pressure levels in relation to maternal pre-pregnancy body mass index

We evaluated the influence of maternal pre-pregnancy body mass index (BMI), based on reported pre-pregnancy weight and height, on blood pressure (BP) levels during pregnancy by using information from a prospective cohort of 1733 women recruited before 20 weeks' gestation. Maternal antenatal BP values were abstracted from medical records, and we evaluated the mean BP differences according to BMI group in regression models, using generalised estimating equations to account for repeated BP records within each pregnancy. In each trimester, mean systolic BP (SBP) and diastolic BP (DBP) values were positively associated with maternal pre-gestational BMI. This association persisted after adjustment for maternal age, parity, smoking, education, marital status and physical activity. Overweight women (25-29 kg/m(2)) had first-, second- and third-trimester mean SBPs that were 8.1, 7.7 and 8.2 mmHg, respectively, higher than values observed in lean women (<20 kg/m(2)). Mean DBP values were 4.5, 5.4 and 5.6 mmHg higher for each successive trimester in overweight vs. lean women. Obese (>30 kg/m(2)) women consistently had the highest mean SBP and DBP values. Trimester-specific mean SBP values were 10.7-12.0 mmHg higher among obese women vs. lean women. Corresponding trimester-specific mean DBP values were 6.9-7.4 mmHg higher in obese vs. lean women. Similar patterns were observed when trimester-specific average mean arterial pressures were evaluated. Elevated pregnancy BPs associated with maternal pre-gestational BMI are consistent with a large body of literature that documents increased pre-eclampsia risk among overweight and obese women.     

Body fat distribution, serum lipoproteins and blood pressure in middle-aged Finnish men and women

The association of body fat distribution as measured by the ratio of waist to hip girth (WHR) to age, to serum total cholesterol and HDL-cholesterol and to blood pressure was studied in a population-based sample of 2461 men and 2768 women aged 25 to 64 years not treated with cardiovascular drugs. In men, the relationships of age with WHR and age with body mass index (BMI) were similar, an increase levelling at the age of about 50 years. In women, BMI increased linearly, but WHR exponentially with age. In both sexes, age-adjusted WHR and BMI associated positively with non-HDL cholesterol, and with systolic and diastolic blood pressure, and inversely with HDL-cholesterol and the HDL/non-HDL cholesterol ratio. WHR and BMI were independently related to several cardiovascular risk factors. HDL-cholesterol concentration was 19% lower in men, and 17% lower in women who belonged to the upper tertile of both WHR and BMI, than in the subjects in the lower tertiles of WHR and BMI. Age-adjusted WHR and BMI also predicted fasting and 2-hour post-challenge blood glucose values in women aged 45 to 64 years, but not in men. The WHR provides additional information on elevated cardiovascular risk factors in cross-sectional analysis among middle-aged men and women independently of BMI. The measurement of WHR in large-scale risk factor surveys should be recommended, in order to assess the independent contribution of WHR to the risk of cardiovascular disease, and to find out the importance of WHR for the prevention of chronic diseases.     

Shiftwork and metabolic risk factors of cardiovascular disease

We conducted this study to examine the relationship between shift work duration and the metabolic risk factors of cardiovascular disease among shift workers. The study population consisted of 226 female hospital nurses and 134 male workers at a firm manufacturing diapers and feminine hygiene materials, whose mean ages were 28.5 yr for the nurses and 29.1 yr for the male workers. The fasting blood sugar level, serum cholesterol, blood pressure, height and weight, waist and hip circumferences (only for the nurses), and numbers of walks during work (as a measure of physical activity) were measured. Using the Karasek's job contents questionnaire, job stress was assessed. Information about the years of work, shift work duration, past medical and behavioral history, including smoking, was obtained by a self-administered questionnaire. With definitions of hypertension as systolic blood pressure (SBP) > or =160 or diastolic blood pressure (DBP) > or =90 mmHg occurring at least once, hypercholesterolemia as serum total cholesterol > or =240 mg/dl, obesity as body mass index (BMI) > or =25 kg/m(2) and as waist to hip ratio (WHR) > or =0.85, we examined the prevalences of metabolic risk factors among subjects. Regression analyses to show the relationships between shift work duration and metabolic risk factors were performed using simple and multivariate models stratified by age, and adjusted for smoking, drinking, job strain and physical activity. Duration of shift work was significantly associated with SBP or cholesterol level among male workers aged 30 or more. Among female nurses, it was inversely associated with DBP (in those who were below 30 yr old) and cholesterol (in those who were aged 30 or more). BMI was non-significantly associated with the duration of shift work in both male workers and female nurses who were 30 yr old or more. WHR in female nurses increased slightly according to increasing duration of shift work. Fasting blood sugar was not significantly associated with the duration of shift work in either sex regardless of age-group. These results suggest an association between shift work duration and the metabolic risk factors of cardiovascular disease.     

Mean levels and distribution of some risk factors for atherosclerosis in Sardinia: The ATS-Sardegna survey

Six population samples of randomly chosen men and women aged 20–59 years in the four provinces of the island of Sardinia, for a total of 5,697 individuals (overall partecipation 55%), were examined to determine the mean levels and distribution of some risk factors for atherosclerosis. A remarkable uniformity of such levels, with some minor exceptions, was found throughout the island. The overall, age-standardized mean levels for the factors considered are as follows (men and women, respectively): total cholesterol (TC) (mg/dl) 204 and 196; LDL-cholesterol (LDL-C) (mg/dl) 131 and 125; apolipoprotein B (ApoB) (mg/dl) (five out of six areas) 112 and 104; HDL-cholesterol (HDL-C) (mg/dl) 48 and 53; triglyceride (TG) (mg/dl) 117 and 89; systolic blood pressure (mmHg) 129 and 128; diastolic blood pressure (mmHg) 81 and 80; body mass index (BMI) [kg/(m)²] 26 and 25; prevalence of smokers (%) 48 and 15; cigarettes per day among smokers 19 and 11. A regular increase with increasing age exists for TC, LDL-C, ApoB, blood pressure (systolic and diastolic) and BMI. Compared to the results of a previous survey eight years earlier, an unfavorable trend is in progress, particularly for TC levels in both sexes and smoking among women.Corresponding author.     

Relationship of socioeconomic status with cardiovascular risk factors and lifestyle in a Mediterranean population

BACKGROUND: Socioeconomic status greatly affects cardiovascular risk factors and lifestyle. Aim of the study To analyse the relationship between socioeconomic status and both cardiovascular risk factors and behavioural variables. AIM OF THE STUDY: To analyse the relationship between socioeconomic status and both cardiovascular risk factors and behavioural variables. METHODS: The present random sample of 838 men and 910 women of the 25 to 74 year old general population of Gerona according to the 1991 census, included cardiovascular risk factor measurements (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, glycaemia, systolic blood pressure, diastolic blood pressure, body mass index, waist to hip ratio, and waist circumferences) and evaluation of dietary habits, alcohol consumption, smoking, and leisure-time physical activity with corresponding questionnaires. RESULTS: In this study, we used lifestyle factors (leisure-time physical activity, tobacco consumption, and alcohol drinking habits) in addition to dietary habits to determine whether changes in these factors correlate with the socioeconomic status, classified as degree of educational level, in a representative Spanish Mediterranean population. Multiple linear regression analysis adjusted for several confounders revealed a direct association of LDL-cholesterol (p = 0.03) and body mass index (p = 0.02) with low levels of educational status in men and women, respectively. A higher educational status was directly (p = 0.04) related to the smoking status in women. The two composite dietary scores, indicating overall dietary quality and cardiovascular protecting properties, were not associated with low socioeconomic status in our population. CONCLUSION: Dietary habits, alcohol drinking, and leisure-time physical activity seems not to be affected by educational status in either gender. This finding might partially explain the relationship between cardiovascular risk factors and socioeconomic status in our population. The importance of cultural values in the rural area of the Spanish province seems to be the stronger factor compared with education.