Coronary heart disease risk factors in sub-Saharan Africa: studies in Tanzanian adolescents.

STUDY OBJECTIVE--To assess the level of cardiovascular risk factors in young people in sub-Saharan Africa living in rural and urban settings. DESIGN--Cross sectional survey of the population aged 15 to 19 years. SETTING--Eight rural Tanzanian villages in three regions, and two districts in Dar es Salaam. PARTICIPANTS--664 males and 803 females in rural villages and 85 males and 121 females in the city. Response rates for total population were 74% to 94% in the rural areas and 60% in the city. MEASUREMENTS AND RESULTS--Measurements included blood pressure, body mass index, serum lipids, and blood glucose concentrations (fasting and two hours after 75 g glucose). Blood pressure was slightly but significantly higher in young women than in young men (115/67 mmHg versus 113/65 mmHg) and increased significantly with age. Only 0.4% subjects had blood pressure greater than 140 and/or 90 mmHg. There were no urban-rural differences. Body mass index was higher in females (mean (SD) 20.3 (2.8) kg/m2) than males (18.5 (2.1)). Overweight was found in only 0.6% at age 15 years but 5.4% at age 19 years. Serum cholesterol concentrations were low at 3.5 mmol/l in males and 3.7 mmol/l in females. Only 7% had values above 5.2 mmol/l. The highest concentrations were found in the city and in Kilimanjaro, the most prosperous rural region. Serum triglycerides were 1.0 (0.5) mmol/l in males and 1.1 (0.5) mmol/l in females, and were highest in the city dwellers. Diabetes was rare (0.28% males, 0.12% females) but impaired glucose tolerance was present in 4.7% and 4.1% respectively. Drinking alcohol was equally prevalent in males and females, reaching 30% at age 19 years. Only 0.4% of females smoked compared with 7.3% of males. Smoking was commoner in rural areas that in the city. CONCLUSIONS--Several risk factors for cardiovascular disease were found in Tanzanian adolescents, but levels were much lower than in studies reported from developed nations. The challenge is to maintain these low levels as the population becomes more urbanised and more affluent.     

冠心病危险因子在女性冠心病心力衰竭中的研究

目的 探讨冠心病危险因子在女性冠心病患者发生心力衰竭中的影响。方法 选取328例冠心病患者,其中男196例（男性冠心病组）,女132例（女性冠心病组）,对两组患者各种冠心病危险因子包括年龄、高血压、糖尿病、血脂、血浆纤维蛋白原及血尿酸水平等进行比较;对所有患者随访1～3年,观察两组患者心力衰竭发生率,并对女性冠心病组发生心力衰竭者与未发生心力衰竭者的血尿酸水平进行比较。结果 女性冠心病组三酰甘油、血浆纤维蛋白原及血尿酸水平显著高于男性冠心病组(P＜0.05)。随访l～3年,女性冠心病组心力衰竭发生率显著高于男性冠心病组[27.27％(36/132)比16.84％( 33/196)],女性冠心病组发生心力衰竭者血尿酸水平为(368.85±78.60)μmol/L,未发生心力衰竭者血尿酸水平为(336.63±69.65)μmol/L,两者比较差异有统计学意义(P＜0.05)。结论 冠心病危险因子是女性冠心病患者心力衰竭的重要推动因素,而血尿酸是其发生心力衰竭的独立危险因素,可通过对血尿酸等进行早期监测并采取干预措施,减缓疾病的发展。     

冠心病与血脂异常的相关危险因素分析探讨及策略

目的 探讨血脂异常对冠心病相关危险因素的影响,以及它们之间的危险度.方法 从笔者所在医院门诊就诊患者及干部年度健康体检者中随机抽取430例各型高脂血症患者,并在正常对照组中随机抽取160例,分别检测它们的血脂水平,以及分析它们发生冠心病的危险度,并以吸烟、肥胖（体重指数）为辅助因素计算其调整危险度.结果 Ⅰ型、Ⅱ型、Ⅲ型和Ⅳ型高脂血症的冠心病患病率分别为52.10%、55.20%、56.60%和63.44%;对照组的冠心病患病率分别为28.33%和20.00%,与对照组比较,均有显著性差异（P〈0.01）.Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型高脂血症患者与冠心病的调整相对危险度分别是对照组的4、5、6、7倍.结论 血清甘油三酯、胆固醇、高密度脂蛋白异常时冠心病发生的危险度均会升高,高脂血症是冠心病发病最强的预告信号,是重要的可调性间接危险因素之一,控制血脂、戒烟、合理饮食、降低超重和肥胖是预防冠心病的有力措施.     

血脂异常与冠心病及其调脂治疗

经过多年的以及众多的大型临床实验研究证实:血脂异常是动脉粥样硬化、冠心病和脑血管疾病的重要致病因素。血浆高胆固醇(TC)、高甘油三酯(TG)、低密度脂蛋白(LDL)升高和高密度脂蛋白(HDL)降低可造成血管内皮细胞功能受损,内皮依赖性舒张功能降低,内皮通透性增加,加速动脉粥样硬化的发展;内皮细胞功能受损后,单核巨噬细胞向血管壁的浸润性增加,同时在高脂血症的影响下,单核巨噬细胞表面受体被修饰,吞噬脂质的作用增加,导致大量脂质和胆固醇聚集在浸入于血管内皮下的巨噬细胞之中,形成泡沫细胞,最终形成内膜乃至中膜层中大量脂质和胆固…     

Coronary heart disease: pathophysiological events and risk factors

Summary Cardiovascular disease remains the major cause of morbidity and mortality in the UK, causing more than 110 000 deaths per annum. Coronary risk is multifactorial, being a composite of genetic and environmental determinants. Its major risk factors include hypertension, dyslipidaemia, obesity, plasma clotting factor concentrations, smoking and diabetes mellitus. The overall heritability of coronary heart disease has been estimated to be between 15 and 50%, and hence, there is a substantial potential role for environmental factors, including diet, to modify coronary risk. Studies in experimental animal models have permitted a more detailed analysis of the cellular events by which atherosclerosis is initiated and progresses. This work has identified the endothelium as a primary site of injury, leading to endothelial dysfunction. Detailed histological and radiological studies in man have led to the identification of features of atherosclerotic plaques that make them more vulnerable to abrupt rupture. The possible role of infection and inflammation in this process is supported by epidemiological data. These new insights into the pathogenesis of atherosclerosis have been accompanied by the identification of a new generation of risk factors.     

Coronary heart disease risk factors in bus and truck drivers

Fifty-two bus and truck drivers and a control group of 52 male industrial workers were studied with regard to risk factors for coronary heart disease (CHD) as well as some psycho-social and occupational indicators. The main results were: higher mean values for serum cholesterol, serum triglycerides and blood pressure in the driver group, indicating a markedly higher risk of CHD in the driver group. The two groups were matched for age, socio-economic status, dietary habits, smoking habits and alcohol consumption. In the study the groups were found to be equal as regards CHD-inheritance, physical activity in leisure time, and relative body weight, W/H2. No CO could be traced in the vehicles. The psycho-social and occupational indicators showed considerable differences. The average score for the exposure factor "tempo/time-limit/urgency in job" was 50% higher, and the number of persons with the characteristic "type-A coronary-prone behaviour" was 30% higher in the driver group than in the control group. The difference in blood lipids and blood pressure increased with age. It is suggested that the higher CHD-risk in the driver group is associated with two factors: (1) greater psychic pressure in the working situation; (2) the selection of more type-A persons to driver occupations. A probable, but not commonly accepted theory, is that these psychosocial indicators may influence the traditional risk factors in a harmful way.     

Coronary heart disease risk factors in urban bus drivers

The purpose of this study was to determine the risk factors for coronary heart disease (CHD) in 2297 bus drivers and skilled workers from the Taipei Municipal Bus Administrative Bureau. Data for this study were compiled from the medical records of annual physical examinations for bus drivers and skilled workers conducted at Taipei Municipal Chronic Disease Hospital during the period from July 1998 to June 1999. The results showed that, after adjustment for age, hypertension rates for bus drivers (56.0%, 986/1361) were significantly greater than for skilled workers (30.6%, 164/536). All age groups demonstrated a similar difference. Significant differences were also noted in body mass index, serum cholesterol, serum triglyceride and ischemic heart disease between bus drivers and skilled workers. Among bus drivers, the prevalence of obesity was 9.6%, hypercholesterolemia 34.0%, hypertriglyceridemia 69.4% and ischemic heart disease 1.7%. By contrast, among skilled workers, the prevalence of obesity was only 4.6%, hypercholesterolemia 29.9%, hypertriglyceridemia 30.6% and ischemic heart disease 0.9%. These findings suggest that exposure to the occupation of driving a bus may carry an increased risk of CHD and that drivers who develop signs of cardiovascular illness should be transferred to non-driving occupations within the company.     

Coronary heart disease incidence in diabetic patients,and its relationship to general risk factors

The five-year incidence of coronary heart disease (CHD) was examined in middle-aged diabetics (54 insulin-dependent — IDDM, 152 non-insulin-dependent — NIDDM) and 105 controls. In comparison to the controls, CHD incidence was higher only in IDDM patients (11.5 vs 4.0%), but the difference was not a significant one. CHD incidence cases in both IDDM and NIDDM groups were significantly related with longer duration of the disease and, when IDDM patients are concerned, with higher diastolic blood pressure.     

Coronary heart disease risk factors: prevalence and behavior among male university students in Dammam City, Saudi Arabia

Smoking, hypertension, and diabetes mellitus are the common risk factors among patients with coronary heart disease (CHD). High dietary fat intake, smoking, and lack of physical exercise have all been documented as independent risk factors for the development of CHD. The aim of the present study was to determine the prevalence of CHD risk factors among King Faisal University (KFU) male students in Dammam city, Saudi Arabia. A sample size of 10% of the target population (2054 male students of KFU colleges) was selected comprising 205 students. The study sample was selected by a multistage stratified random sampling technique with proportional allocation from all class levels. The response rate was 77.6%, where a total of 159 students were included in the study. Data was collected using an interviewer-administered questionnaire, which included sociodemographic variables and risk factors for CHD. The following measurements were performed: weight, height, body mass index (BMI), waist-to-hip ratio (WHR), blood pressure, and random capillary blood glucose. It was found that 28.9% of the university students do not practice any type of physical exercise. About 19% of the students were current smokers. A high proportion of university students were consuming fast foods, saturated fats, and soft drinks. Overweight (24.5%), obesity (11.9%), severe obesity (10.7%) as measured by BMI, as well as unacceptable WHR (10.7%) as an indicator of obesity were evident. Family history of obesity and unacceptable WHR were found to be statistically associated with increased obesity. Therefore, intervention programs to raise the health awareness of adolescents about CHD risk factors and encourage them to adopt a healthy dietary behavior, promote physical exercise and smoking cessation should be initiated.     

Prevalence of coronary heart disease risk factors in Costa Rican adolescents.

PURPOSE: To determine the prevalence of coronary heart disease (CHD) risk factors among Costa Rican adolescents. METHODS: The prevalence of high blood pressure, obesity, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, sedentarism, family history of premature CHD, saturated fat intake, diabetes mellitus, and cigarette smoking was determined in 328 adolescents, ages 12-18 years (167 males, 161 females), randomly selected from San José's urban and rural high schools. RESULTS: Over 70% of the adolescents studied presented one risk factor for CHD. While the prevalence of family history of premature CHD, sedentarism, and cigarette smoking was significantly higher in urban adolescents, low HDL cholesterol and high blood pressure were significantly higher in rural adolescents. Girls demonstrated a significantly higher prevalence of sedentarism and LDL cholesterol >2.9 mmol/L than boys. Elevated saturated fat intake (>10% total energy) was found in 37% of the adolescents. CONCLUSIONS: The prevalence of CHD risk factors among Costa Rican adolescents is high; particularly of saturated fat intake, sedentarism and low HDL-C levels. Primary prevention programs are urgently needed, especially among female adolescents and in the urban areas, to reduce the increased prevalence of CHD mortality among Costa Rican adults.     

Coronary heart disease risk factors in men with light and dark skin in Puerto Rico.

The association of skin color with coronary heart disease risk factors was studied in 4,000 urban Puerto Rican men. Skin color on the inner upper arm was classified according to the von Luschan color tiles. Using this grading, men were separated into two groups of light or dark skin color. The dark group had a lower socioeconomic status (SES) based on income, education, and occupation. Dark men had slightly higher mean systolic blood pressures (SBP) and lower mean serum cholesterol levels than the light, but the relative weights and cigarette smoking habits of both groups were similar. After controlling for the differences in SES, skin color showed a small but statistically significant association with SBP. Whether this association with skin color represents genetic or environmental influences on SBP could not be determined from this study.     

Emotional intelligence and smoking risk factors in adolescents: interactions on smoking intentions.

PURPOSE: To examine interactions between emotional intelligence (EI) and smoking risk factors on smoking intentions in adolescents. METHODS: EI ios defined as the ability to: accurately perceive, appraise, and express emotion; access and/or generate feelings in facilitating thought; understand emotion and emotional knowledge; and regulate emotions. EI of 416 6th graders (53% girls) from middle schools in the Los Angeles area (mean age = 11.3 years; 32% Latino, 29% Asian/Pacific Islander, 13% white, 19% Multiethnic, 6% Other) was assessed with an abbreviated version of the Multifactor Emotional Intelligence Scale, Adolescent Version (MEIS). This was a competence-based measure assessing an individual's ability to perceive, understand, and manage emotion. Logistic regression models were fit to test interactions between EI and ever trying cigarettes, hostility, and perceived ability to refuse a cigarette from someone just met, on intentions to smoke in the next year. RESULTS: High EI adolescents were more likely to intend to smoke in the next year if they had previously experimented with smoking. Those with low EI were more likely to intend to smoke if their perceived ability to refuse a cigarette offer from a person they just met was low or hostility level was high. CONCLUSIONS: These preliminary results indicate that EI interacts with risk factors to reduce smoking intentions, and contributes evidence to a link between EI and smoking in adolescents.     

Job strain and arterial blood pressure, serum cholesterol, and smoking as risk factors for coronary heart disease in Japan

Objective: To determine the effects of the job demands-control model on arterial blood pressure, serum total cholesterol, and smoking in male daytime and rotating-shift workers in Japan. Methods: The survey was conducted for all employees of an electrical factory in Japan using a mailed questionnaire concerning three job stressors, i.e., job overload, work-pace control, and work-site social support. A blood sample was taken at the same time. Data on 1 703 male daytime workers and 1 173 male rotating-shift workers were analyzed. Multiple logistic regression or analysis of covariance (ANCOVA) were employed to determine the effects of the job stressors on systolic and diastolic blood pressure, serum total cholesterol, and smoking with control for other covariates. Results: Among daytime workers, systolic and diastolic blood pressures were highest in the “high-strain” (i.e., higher job overload + lower work-pace control) group; ANCOVA indicated that a two-way interaction between job overload and work-pace control was significant (P < 0.01). This tendency was not observed among rotating-shift workers. The number of cigarettes smoked per day was greater in groups with lower work-pace control and lower work-site social support among daytime workers (two-way interaction between these two job stressors, P < 0.05); it was greater in groups with lower work-site social support among rotating-shift workers (main effect of work-site social support, P < 0.05). Conclusions: Our study suggest that job strain as defined in the job demands-control model is associated with increased systolic and diastolic blood pressures in male daytime workers in Japan. Smoking might be affected by lower work-site social support. Received: 10 June 1997 / Accepted: 20 March 1998     

Smoking, lipids, glucose intolerance, and blood pressure as risk factors for peripheral atherosclerosis compared with ischemic heart disease in the Edinburgh Artery Study.

The aim was to determine if certain risk factors in the general population are more strongly related to peripheral arterial disease than to ischemic heart disease. Arterial disease in the lower limbs was measured by means of the World Health Organization questionnaire on intermittent claudication, the ankle brachial pressure index, and a reactive hyperemia test in 1,592 men and women aged 55-74 years selected randomly in 1988 from the age-sex registers of 10 general practices in Edinburgh, Scotland. Peripheral arterial disease was strongly related to lifetime cigarette smoking, with additional risks in current and exsmokers of less than 5 years. Multiple regression of risk factors on measures of peripheral arterial disease showed associations with diabetes mellitus (but not impaired glucose tolerance), systolic blood pressure, and serum cholesterol; inverse association with high-density lipoprotein cholesterol; and only univariate association with triglycerides. In multiple logistic regressions of risk factors on six separate indicators of cardiovascular disease, the only consistent difference was that smoking increased the risk of peripheral arterial disease (range of odds ratios, 1.8-5.6) more than heart disease (range of odds ratios, 1.1-1.6). Diabetes mellitus was not a stronger risk factor for peripheral arterial disease.     

High dietary fat intake and cigarette smoking as risk factors for ischaemic heart disease in Bangladeshi male immigrants in East London.

A study was made of smoking and dietary habits in middle aged Bangladeshi men living in East London to investigate possible causes of the previously described high ischaemic heart disease risk in this group. The results showed that these individuals were 50% more likely to smoke than Caucasians living in the same area, after adjusting for age and social class. More striking, however, was the very high fat intake of over 200 g/day, which is twice the national average and accounted for nearly 60% of total energy intake. Interestingly, much of the dietary fat was from vegetable oil, and the ratio of polyunsaturated to saturated fatty acids exceeded the accepted recommended minimum.     

Prevalence and risk factors for smoking among adolescents

OBJECTIVE: Tobacco smoking is one of the main causes of preventable disease and premature disability. The study was aimed at measuring smoking prevalence and related risk factors among adolescents. METHODS: A population-based cross-sectional study was carried out in a representative sample of 1,187 adolescents aged 10 to 19 years living in the urban area of Pelotas, southern Brazil. All adolescents were interviewed separately using a confidential coded questionnaire. Kaplan-Meier test was performed for survival curve analysis. RESULTS: The overall smoking prevalence rate in the sample was 12.1% (95% CI 10.3%-14%). Boys and girls had similar prevalence rates. The following were the risk factors for smoking found in the multivariate logistic regression analysis: older age (OR=28.7; 95% CI 11.5-71.4), older smoking siblings (OR=2.4; 95% CI 1.5-3.8), three or more smoking friends (OR=17.5; 95% CI 8.8-34.8) and low schooling (OR=3.5; 95% CI 1.5-8.0). CONCLUSIONS: The prevalence of smoking among adolescents in the city of Pelotas was high. Campaigns against tobacco use should be aimed at the community and families, targeting adolescents. The government must adopt legal actions in order to prevent adolescents to have access to to smoking.     

Coronary risk factors in middle-aged men as related to smoking, coffee intake and physical activity.

The relationship between lifestyle and coronary risk factors in blood was investigated in 165 middle-aged men. Plasma fibrinogen, serum triacylglycerols (TG), and apolipoprotein B (apo B) were higher, and high density lipoprotein cholesterol (HDLc) lower in smokers (n = 69) than in non-smokers (n = 96). By linear regression analysis there was a significant positive association between degree of smoking and either total cholesterol (TC), apo B, or plasma fibrinogen, whereas smoking was inversely related to HDLc. Smoking and coffee intake were positively correlated with an atherogenic index, reflecting the balance between low and high density lipoproteins. Sedentary men (n = 59) had higher mean TC, apo B, and atherogenic index than physically active men (n = 104). Smokers used salt more often than non-smokers. Physically active men used vegetables more often than sedentary men. Combining several habits into a "bad habit" score gave a high level of significance for its association with TC, apo B, and the atherogenic index. The results indicate that lifestyle may influence several blood factors involved in atherosclerosis development.     

Plasma lipids and other cardiovascular risk factors in Costa Rican adolescents.

This study assessed plasma lipids and other cardiovascular risk factors in adolescents in a developing Latin American country and compared those risk factors to those of adolescents in the United States of America, where the risk of heart disease is high. In a cross-sectional study, data were collected from September 1998 to April 1999 on 161 Costa Rican adolescents between the ages of 12 and 20. A general questionnaire was used to collect demographic, smoking, socioeconomic, and women's health data. Anthropometric measurements, blood pressure, and a fasting blood sample were taken. The Costa Rican males had lower levels of total cholesterol than did the Costa Rican females (mean +/- standard error of the mean (SEM), 149 +/- 6.5 mg/dL vs. 158 +/- 6.3 mg/dL). This was mainly due to lower high-density lipoprotein (HDL) cholesterol in males than in females (mean +/- SEM, 38 +/- 2.0 mg/dL vs. 44 +/- 2.4 mg/dL). As compared to the United States, adolescents in this study had lower levels of total cholesterol, largely due to lower HDL cholesterol. Both genders of Costa Ricans had levels of low-density lipoprotein (LDL) cholesterol that were similar to those of counterpart groups in the United States. Costa Rican male and female adolescents had higher LDL/HDL ratios than did their United States counterparts. Therefore, as compared to the United States, Costa Rican adolescents have an adverse lipid profile as demonstrated by a higher LDL/HDL ratio. Overweight prevalence in Costa Rica was 13%, approaching the 15% overall level of the United States.