青岛市成年人体质指数与冠心病发病关联的前瞻性研究

目的 分析青岛市成年人体质指数（BMI）与冠心病发病之间的关联。方法 研究对象来自中国慢性病前瞻性研究青岛市项目点,共纳入33 355名30~79岁研究对象,采用Cox比例风险回归模型,分析BMI与冠心病发病的关联。结果 调查对象平均随访9.2人年,共监测缺血性心脏病（IHD）2 712例,主要冠心病事件（MCE）420例。多因素Cox回归分析显示,与体重正常或过低的人群相比,超重和肥胖人群IHD及MCE的风险增加,超重组发病风险分别增加了41%和87%,HR值（95%CI）分别为1.41（1.27~1.56）和1.87（1.43~2.44）,肥胖组分别增加了91%和143%,HR值（95%CI）分别为1.91（1.72~2.13）和2.43（1.82~3.24）。结论 超重和肥胖会增加IHD和MCE的发病风险。     

Twins, smoking and mortality: a 12-year prospective study of smoking-discordant twin pairs

Despite the increasing scientific evidence for a causal role of tobacco smoking in lung cancer and coronary heart disease, critics, several decades ago, put forward an alternative hypothesis. The constitutional hypothesis has stated that there are genetic or other common factors, which predispose both to smoking and disease, but that the two are not causally related. A critical test of this hypothesis is the study of disease in monozygotic (MZ) twin pairs in which one smokes and the other never has. Earlier twin studies found only small differences in the mortality of smoking and nonsmoking twins of discordant pairs. In the Finnish Twin Cohort, a population-based panel of adult like-sexed twin pairs, a questionnaire study carried in 1975 permitted identification of twin pairs discordant for cigarette smoking. The nonsmoking cotwins had never been regular smokers. The smoking twins were divided into 1278 current smokers [CS; 143 MZ and 598 dizygotic (DZ) males and 171 MZ and 585 DZ females] and 1210 former smokers (FS; 129 MZ and 408 DZ males and 113 MZ and 341 DZ females). Exposure to tobacco was much higher among males; over 25% of men smoked 20 or more cigarettes daily compared to less than 10% of women. Follow-up of mortality yielded data on time and cause of death. Analyzing on first deaths from concordant pairs, there were 13 deaths in the smokers of male CS MZ pairs and 1 death in the nonsmoking cotwins (relative risk = 13.0, P less than 0.01). Excess mortality was also found for male CS DZ smokers (RR = 2.43, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Association of adiponectin with coronary heart disease and mortality: the Rancho Bernardo study

Hypoadiponectinemia has been implicated in the development of obesity-related conditions, including dyslipidemia and coronary heart disease (CHD). In this study, the authors examined the association of adiponectin with CHD prevalence, incidence, and mortality among 1,513 community-dwelling men and women aged 50-91 years who were followed from 1984-1987 through 2004. In cross-sectional analyses, adiponectin concentrations were positively related to female sex, age, and high density lipoprotein cholesterol level and inversely related to waist girth, triglyceride level, and fasting plasma glucose level (all p's < 0.001). Adiponectin levels in the highest sex-specific quintile, as compared with the lowest, were associated with 44% decreased odds of prevalent CHD (p for trend = 0.03); adjustment for high density lipoprotein cholesterol and/or triglycerides eliminated this association. In 20-year prospective analyses, higher adiponectin concentrations predicted reduced risk of nonfatal myocardial infarction in men only; adiponectin was not associated with fatal incident CHD events or 20-year CHD mortality (n = 215 deaths) in either sex. Adiponectin levels in the highest sex-specific quintile, as compared with lower levels, were associated with almost 40% increased risks of cardiovascular disease death (n = 441) and death from all causes (n = 925), independent of age, sex, waist girth, lipid levels, and glucose level (both p's < 0.001). These results suggest that use of adiponectin for cardiovascular disease risk stratification is premature.     

The relation between dietary flavonol intake and coronary heart disease mortality: a meta-analysis of prospective cohort studies

OBJECTIVE: To assess the association of dietary flavonol intake with the subsequent risk of coronary heart disease (CHD) mortality. DESIGN: Meta-analysis of prospective cohort studies published before September 2001. Studies were identified by MEDLINE and EMBASE searches and by scanning relevant reference lists. The following information was extracted from published reports: size of cohort, mean age, mean duration of follow-up, number of fatal CHD events, mean flavonol intake, main sources of flavonol intake, degree of adjustment for potential confounders, and the relation of CHD mortality to dietary flavonol intake measured at baseline. RESULTS: Seven prospective cohorts of men and women were identified including a total of 2087 fatal CHD events. Comparison of individuals in the top third with those in the bottom third of dietary flavonol intake yielded a combined risk ratio of 0.80 (95% CI 0.69-0.93) after adjustment for known CHD risk factors and other dietary components. CONCLUSION: This overview of prospective cohort studies indicates that high dietary intake of flavonols from a small number of fruits and vegetables, tea and red wine may be associated with a reduced risk from CHD mortality in free-living populations.     

携带载脂蛋白E的HDL-C与冠心病发病风险的前瞻性队列研究

目的:探讨我国人群携带载脂蛋白E的HDL-C（APOE-HDL-C）与冠心病发病风险的关系。方法:选择中国多省市心血管病队列研究中参加2002年或2007年心血管病危险因素调查并随访至2013年12月31日的研究对象5 417人（排除基线有心血管病者）。检测研究对象基线APOE-HDL-C和总HDL-C水平。计算APO...     

中国成年人中心性肥胖与缺血性心脏病发病风险的前瞻性研究

目的 分析中心性肥胖评价指标腰围与发生缺血性心脏病（IHD）、急性冠心病事件（MCE）以及死于IHD风险的关联。方法 研究对象来自中国慢性病前瞻性研究,基线调查开展于2004年6月至2008年7月,剔除基线时患有冠心病、脑卒中、恶性肿瘤、慢性阻塞性肺疾病和糖尿病的个体,共纳入428 595人进行分析。统计学分析采用Cox比例风险模型。结果 研究人群平均随访9.1年,累积随访3 803 637人年,期间新发IHD 26 900例,MCE 4 320例,IHD死亡2 787例。调整了多种混杂因素和BMI后,与非中心性肥胖者（男性<85.0 cm,女性<80.0 cm）相比,中心性肥胖前期者（男性85.0～89.9 cm,女性80.0～84.9 cm）发生IHD、MCE和死于IHD的风险HR值（95% CI）分别为1.13（1.09～1.17）、1.15（1.05～1.26）、1.11（0.98～1.24）,中心性肥胖者（男性≥90.0 cm,女性≥85.0 cm）对应的风险效应值更高,HR值（95% CI）分别为1.29（1.24～1.34）、1.30（1.17～1.44）、1.32（1.16～1.51）。按BMI分层,即使在BMI正常的人群中,与非中心性肥胖者相比,中心性肥胖前期和中心性肥胖人群发生IHD、MCE或死于IHD的风险也会增加。结论 中心性肥胖是IHD风险独立的危险因素,IHD风险随中心性肥胖测量指标腰围的增加而增加。     

社区居民肥胖、中心性肥胖与冠心病发病风险的前瞻性队列研究

目的探索肥胖、中心性肥胖与冠心病发病风险的关系。方法 2013年在上海市浦东新区社区居民中采用多阶段分层随机抽样选取人群开展基线调查,收集6 685名队列研究对象的人口学特征、暴露因素、身体测量指标等信息。随访观察中位时间3.00年,记录队列人群的冠心病发病情况。单因素分析采用t检验、Kruskal-Wallis检验和卡方检验,多因素分析采用COX比例风险模型。结果队列总计观察人年数为19 759.93人年,共有260人发生冠心病,男性101例,女性159例。队列人群总体发病率3.89%,发病密度13.16/千人年。冠心病发病率随BMI升高呈上升趋势(χ²_趋势=6.761,P=0.009)。中心性肥胖人群发病风险是正常人群的1.39倍(P=0.019, 95%CI:1.06-1.82),中心性肥胖合并高血压患者发生冠心病的风险是正常人群的1.77倍(P=0.001, 95%CI:1.26-2.49)。结论中心性肥胖是冠心病发病的重要危险因素。     

妊娠高血压综合征、剖宫产与围产儿死亡关系的前瞻陛研究

度和重度妊高征组分别为0.81(0.64～1.02)、1.94(1.41～2.67)和3.32(1.92～5.75);产时、孕晚期和孕中期发病组分别为0.82(0.63～1.05)、1.51(1.14～2.00)和2.67(1.52～4.70).结论 妊高征病情越重、发病时间越早,围产儿死亡危险越高;剖宫产可降低妊高征患者的围产儿死亡危险.     

冠心病基因检测与冠心病的关联性

目的观察冠心病基因检测与冠心病是否有关联性,以及关联程度如何。方法选取120例住院患者,其中60例为冠心病人,60例为非冠心病人。年龄40—65岁。冠心病为观察A组,非冠心病为对照B组,记录性别、年龄、冠心病家族史、高血压史、糖尿病史,并均抽血行冠心病基因检测。A组选1人和B组选1人按年龄相近、性别相同配对,共形成60对。开始进行1：1条件Logistic回归分析。结果冠心病家族史、高血压史、糖尿病史、以及冠心病基因检测与冠心病均有关联性。其中冠心病基因检测与冠心病的关联程度低于其他3个因素。结论冠心病基因检测与冠心病有关联性。     

Association between pleural plaques and coronary heart disease.

OBJECTIVE: The aim of this study was to verify a clinical impression that patients with coronary heart disease disproportionately frequently have calcified pleural plaques. METHODS: Chest X-rays were collected from 148 patients referred consecutively to the Helsinki University Central Hospital for coronary angiography and from 100 consecutive lung cancer patients seen at the same hospital. The radiographs were analyzed for the presence of calcified pleural plaques according to the classification the International Labour Office. A generalized linear model with binomial distribution and log link was used to estimate the relative risks and their 95% confidence intervals (95% CI). RESULTS: The prevalence of calcified pleural plaques was 35% for the coronary patients and 19% for the lung cancer patients. Calcified pleural plaques were more common among the men than the women, and the risk increased with age. The relative risk of calcified pleural plaques, adjusted for age and gender, was 2.19 (95% CI 1.44-3.32) for the coronary patients as compared with the lung cancer patients. CONCLUSIONS: Further studies with better information on past exposure to asbestos and other potential risk factors are warranted to confirm the observations and to examine whether the association between coronary heart disease and calcified pleural plaques is related to an etiologic or an individual susceptibility factor common to both of these conditions.     

Association within twin pairs for a dichotomous trait

We propose an odds-ratio measure of twin association for a dichotomous trait. This odds ratio can be estimated without arbitrarily specifying an index twin and without estimating additional nuisance parameters. Tests of association and confidence intervals may be computed easily, in contrast to those proposed previously [Donner et al. (1995) Genet Epidemiol 12:267–277] for a correlation measure of association. For testing homogeneity of association in two samples of twins, monozygotic and dizygotic, we propose a large-sample test and an exact test, both based on the odds-ratio parameterization. Large-sample tests of homogeneity are slightly anti-conservative when some cell counts are small, and the exact test may be preferred in these situations. We also propose a log-linear parameterization useful for modeling more complex data sets. © 1996 Wiley-Liss, Inc.     

Adult height and cause-specific mortality: a large prospective study of South Korean men

To examine the relation of adult height with mortality, the authors conducted a cohort study of 386,627 middle-aged South Korean male civil servants from 1992 to 1998. An inverse association between height and all-cause mortality (14,003 deaths) was observed after adjustment for socioeconomic position and major behavioral risk factors. The adjusted relative risk for all-cause mortality associated with a 5-cm increment in height was 0.97 (95% confidence interval: 0.95, 0.98). There was little evidence of associations for coronary heart disease or overall cancer mortality. However, stomach cancer showed a weak inverse association that was attenuated after adjustment. Strong inverse associations with death from stroke, respiratory disease, and external causes were observed. The association with stroke mortality was specific for hemorrhagic stroke. The inverse associations observed between height and mortality suggest a possible effect of childhood environment on health. Variations in the associations by cause of death indicate that specific processes are involved. These data are consistent with those of other studies in suggesting that risk of hemorrhagic stroke is particularly influenced by adversity in early life. The lack of an association between height and coronary heart disease suggests that additional factors are required for short stature to translate into increased coronary heart disease risk.     

血脂异常与非酒精性脂肪肝发病关系前瞻性队列研究

目的 了解血脂异常与非酒精性脂肪肝(NAFLD)发病的关系,为NAFLD的预防控制提供参考依据.方法 采取前瞻性队列研究,于2014年1-12月采用方便抽样方法在天津市第一中心医院健康管理科抽取2658名非NAFLD体检者进行随访调查,分析血脂异常与NAFLD发病的关系.结果 2 658名非NAFLD体检者在4年中共发...     

Psychosocial determinants of coronary heart disease in middle-aged women: a prospective study in Sweden

A social gradient in coronary heart disease (CHD) has been documented in a variety of settings, predominantly among men. This study aimed to establish whether a social gradient in CHD existed in a group of Swedish women and whether it could be explained by established coronary risk factors or psychosocial factors. The Women's Lifestyle and Health Cohort Study includes 49,259 women from Sweden aged 30-50 years at baseline (1991-1992), when an extensive questionnaire was completed. There was complete follow-up through linkages to national registries until the end of 2002, during which time 210 cases of incident fatal CHD or nonfatal myocardial infarction occurred. Risk of CHD was significantly inversely related to years of education, the socioeconomic status proxy (hazard ratio comparing the lowest with the highest education group = 3.3, 95% confidence interval: 2.2, 4.7). This association was reduced after adjustment for established coronary risk factors (smoking, body mass index, alcohol consumption, diabetes, hypertension, exercise; hazard ratio = 1.9, 95% confidence interval: 1.3, 2.8). Job strain and social support were weakly related to CHD and did not explain the gradient by years of education. Self-rated health was strongly related to CHD, mediated by established coronary risk factors. Results show a strong gradient in CHD by years of education explained by established coronary risk factors but not by job strain or social support.     

Ambient temperature and coronary heart disease mortality in Beijing, China: a time series study

ABSTRACT: BACKGROUND: Many studies have examined the association between ambient temperature and mortality. However, less evidence is available on the temperature effects on coronary heart disease (CHD) mortality, especially in China. In this study, we examined the relationship between ambient temperature and CHD mortality in Beijing, China during 2000 to 2011. In addition, we compared time series and time-stratified case-crossover models for the non-linear effects of temperature. METHODS: We examined the effects of temperature on CHD mortality using both time series and time-stratified case-crossover models. We also assessed the effects of temperature on CHD mortality by subgroups: gender (female and male) and age (age > =65 and age < 65). We used a distributed lag non-linear model to examine the non-linear effects of temperature on CHD mortality up to 15 lag days. We used Akaike information criterion to assess the model fit for the two designs. RESULTS: The time series models had a better model fit than time-stratified case-crossover models. Both designs showed that the relationships between temperature and group-specific CHD mortality were non-linear. Extreme cold and hot temperatures significantly increased the risk of CHD mortality. Hot effects were acute and short-term, while cold effects were delayed by two days and lasted for five days. The old people and women were more sensitive to extreme cold and hot temperatures than young and men. CONCLUSIONS: This study suggests that time series models performed better than time-stratified case-crossover models according to the model fit, even though they produced similar non-linear effects of temperature on CHD mortality. In addition, our findings indicate that extreme cold and hot temperatures increase the risk of CHD mortality in Beijing, China, particularly for women and old people.     

Milk, coronary heart disease and mortality

STUDY OBJECTIVE: To study the association between reported milk consumption and cardiovascular and all cause mortality. DESIGN: A prospective study of 5765 men aged 35-64 at the time of examination. SETTING: Workplaces in the west of Scotland between 1970 and 1973. PARTICIPANTS: Men who completed a health and lifestyle questionnaire, which asked about daily milk consumption, and who attended for a medical examination. MAIN RESULTS: 150 (2.6%) men reported drinking more than one and a third pints a day, Some 2977 (51.6%) reported drinking between a third and one and a third pints a day and 2638 (45.8%) reported drinking less than a third of a pint a day. There were a total of 2350 deaths over the 25 year follow up period, of which 892 deaths were attributed to coronary heart disease. The relative risk, adjusted for socioeconomic position, health behaviours and health status for deaths from all causes for men who drank one third to one and a third pints a day versus those who drank less than a third of a pint was 0.90 (95% CI 0.83, 0.97). The adjusted relative risk for deaths attributed to coronary heart disease for men who drank one third to one and a third pints a day versus those who drank less than one third of a pint was 0.92 (95% CI 0.81, 1.06). CONCLUSIONS: No evidence was found that men who consumed milk each day, at a time when most milk consumed was full fat milk, were at increased risk of death from all causes or death from coronary heart disease.