Prevalence and risk of colorectal polyps among the Korean population under 50 years

Colorectal cancer is a common cancer; generally, adults aged ≥ 50 years are screened using stool occult blood tests and colonoscopy. However, colorectal adenoma and cancer have been found in patients under the aged of 50, and studies on characteristics and risk factors in young patients are lacking. We evaluated the prevalence and risk factors of colorectal adenoma and cancer in young adults aged under 50 years.We retrospectively analyzed 570 individuals aged under 50 years who underwent colonoscopy at the Haeundae Paik Hospital, Korea, from January to June 2018. Logistic regression model was used to identify the risk factors for colorectal adenoma and colorectal cancer.The prevalence of colorectal adenoma in group of 19–29 years was 3.2% (1 of 31), 30–39 years was 13.8% (30 of 217) and in the group of 40–49 years was 21.1% (68 of 322) (P = .009). In multivariable analysis, age over 45 years (adjusted odds ratio [OR], 1.941; 95% confidence interval [CI], 1.187–3.172; P = .008) and male sex (adjusted OR, 1.711; 95% CI, 1.044–2.806; P = .033) were independent risk factors for colorectal neoplasia including cancer.The prevalence of colorectal adenoma increases as the age increased in young adults under 50 years of age, especially after the age of 45 years, the risk of colorectal neoplasia increases; hence, early screening should be considered before the age of 50 years.     

Prevalence of colorectal adenomas in asymptomatic young adults: a window to early intervention?

Objective The prevalence of colorectal adenoma is increasing in the average-risk population. However, little research is available on colorectal adenoma in young adults under age 40. The aim of this study was to investigate the prevalence and risk factors of colorectal adenoma in 20- to 39-year-old adults. Methods We evaluated 4286 asymptomatic young adults aged 20 to 39 years who underwent first colonoscopy screening as part of an employer-provided health wellness programme at the Health Promotion Centre of Samsung Changwon Hospital, Korea from January 2011 to December 2013. Logistic regression modelling was used to identify risk factors for colorectal adenoma in asymptomatic young adults. Results The prevalence of colorectal adenoma and advanced adenoma was 11.6% (497/4286) and 0.9% (39/4286), respectively. By age group, the prevalence of colorectal adenoma was 5.4% (33/608) in participants aged 20 to 29 years and 12.6% (464/3678) in participants aged 30 to 39. Colorectal adenoma was found in 13.1% (403/3072) of men and 7.7% (94/1214) of women. Increased risk of colorectal adenoma was associated with age over 30 years (OR, 2.37; 95% CI, 1.64–3.42), current smoker status (OR, 1.48; 95% CI, 1.14–1.91), and alcohol consumption (OR, 1.29; 95% CI, 1.03–1.63). Conclusions Our findings indicate that even if the prevalence of colorectal adenoma was low in young adults aged 20 to 39, being over 30, cigarette smoking, and alcohol consumption can affect young adults who have no other CRC risks.     

Characteristics of and risk factors for colorectal neoplasms in young adults in a screening population

AIM: To investigate prevalence and risk factors for colorectal neoplasms in adults aged 50 years, for whom screening is not recommended.METHODS: This cross-sectional study compared prevalence and characteristics of colorectal and advanced adenomas in patients aged 50 years who underwent colonoscopy screening with subjects aged ≥ 50 years. To evaluate risk factors for colorectal and advanced adenoma in young adults, we used multivariable logistic regression models. Colorectal neoplasm characteristics were evaluated and compared with those in older patients.RESULTS: Among 2819 patients included, prevalences of colorectal adenoma and advanced adenoma were 19.7% and 1.5%, respectively. As patient age increased, so did the prevalence of colorectal neoplasm. However, prevalence of advanced adenoma did not differ between age-groups 45-49 years and ≥ 50 years(OR = 0.43, 95%CI: 0.17-1.07, P = 0.070). In younger age-group( 50 years), colorectal adenoma was significantly associated with older age, waist circumference(OR = 1.72, 95%CI: 1.15-2.55, P = 0.008), and current smoking(OR = 1.60, 95%CI: 1.07-2.41, P = 0.023). Alcohol consumption was an independent risk factor for colorectal advanced adenoma(OR = 3.69, 95%CI: 1.08-12.54, P = 0.037). Multiple neoplasms and large neoplasms(≥ 1 cm) were more prevalent in subjects ≥ 50 years.CONCLUSION: Current screening strategies for colorectal cancer may need to be amended to account for patient age, especially in young subjects with abdominal obesity, current smoking and alcohol consumption.     

prevalence of colorectal neoplasms in young,average risk individuals: A turning tide between East and West

AIM To determine the prevalence of colorectal neoplasia in average risk persons 40-59 years of age in Israel and to compare the results with other populations. METHODS We reviewed the results of asymptomatic average-risk subjects, aged 40 to 59 years, undergoing their first screening colonoscopy between April 1994 and January 2014. The detection rates of adenoma, advanced adenoma(AA) and colorectal cancer(CRC) were determined in the 40's and 50's age groups by gender. The prevalence of lesions was compared between age groups. After meticulous review of the literature, these results were compared to published studies addressing the prevalence of colorectal neoplasia in similar patient groups, in a variety of geographical locations.RESULTS We included first screening colonoscopy results of 1750 individuals. The prevalence of adenomas, AA and CRC was 8.3%, 1.0% and 0.2% in the 40-49 age group and 13.7%, 2.4% and 0.2% in the 50-59 age group, respectively. Age-dependent differences in adenoma and AA rates were significant only among men(p 0.005). Literature review disclosed 17 relevant studies. As expected, in both Asian and Western populations, the risks for overall adenoma and advanced adenoma was significantly higher in the 50's age group as compared to the 40's age group in a similar fashion. The result of the current study were similar to previous studies on Western populations. A substantially higher rate of adenoma, was observed in studies conducted among Asian populations in both age groups.CONCLUSION The higher rate of colorectal neoplasia in Asian populations requires further investigation and reconsideration as to the starting age of screening in that population.     

Effect of age on atherogenicity of LDL and inflammatory markers in healthy women

Background and aimSince using LDL level alone is insufficient as a method to identify individuals with incident coronary artery disease (CAD), other factors may be implicated in the pathogenesis of CAD. Additionally, controversy still remains regarding whether there is an age-related increase in circulating cytokines in healthy individuals. We investigated the influence of age on atherogenicity of LDL and inflammatory markers in healthy women.Methods and resultsTwo thousand nine hundred forty four healthy women form 30–79 years old (23.3 ± 0.05 kg/m²) were categorized into 5 age groups: 30–39, 40–49, 50–59, 60–69 and 70–79 years. BMI, smoking, drinking, and metabolic syndrome prevalence adjusted mean values of total-cholesterol progressively increased from the group age 30–39 years to the group age 40–49 and 50–59 years and thereafter decreased in the group age 60–69 and 70–79 years. Serum concentrations of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were higher in women aged 60–79 years than women aged 30–59 years. Plasma ox-LDL levels increased in the group age 50–59 years compared with the group age 30–39 and 40–49 years and further increased in the group age 60–69 and 70–79 years. Mean values of LDL particle size were smaller in women aged 60–79 years than those in women aged 30–59 years. After adjustment for BMI, smoking, drinking, and metabolic syndrome status, age was positively correlated with LDL-cholesterol (r = 0.095, P < 0.001), oxidized LDL (r = 0.305, P < 0.001), hs-CRP (r = 0.150, P < 0.001), TNF-α (r = 0.171, P < 0.001) and IL-6 (r = 0.294, P < 0.001) and negatively with LDL particle size (r = ?0.239, P < 0.001).ConclusionOur results indicate that LDL atherogenicity and inflammatory mediators can be better markers of CAD risk than known risk factors such as elevated concentrations of total- and LDL-cholesterol, decreased HDL-cholesterol levels and smoking in old healthy women.     

Excessive alcohol consumption favours high risk polyp or colorectal cancer occurrence among patients with adenomas: a case control study.

BACKGROUND AND AIMS: Excessive alcohol consumption is a risk factor for developing colorectal adenomas. This study aimed to investigate the influence of excessive alcohol consumption on the occurrence of high risk polyps (adenoma > or = 10 mm, villous component, high grade dysplasia) or colorectal cancer among patients with at least one colonic adenoma. PATIENTS AND METHODS: Three groups of patients with at least one colorectal adenoma were included in a case control study: 401 heavy drinkers (group HD, mean daily alcohol intake 117 (SD 4) g/day for a mean duration of 22 (SD 0.6) years), aged 57 (0.5) years (78% men); 152 patients suffering from irritable bowel syndrome (IBS), aged 61 (0.9) years (57% male); and 108 patients with a family history (FH) of colorectal adenoma or cancer, aged 55 (1) years (64% male). Exclusion criteria were: anaemia, haematochezia, personal history of colorectal adenoma or cancer, and for groups HD and IBS a family history of colorectal adenoma and/or cancer. Relative risks were estimated by the odds ratio (OR) using a logistic regression model and were expressed with 95% confidence interval (CI). RESULTS: After age and sex adjustment, the likelihood of having an adenoma > or = 10 mm was higher in group HD than in the IBS group (OR 1.8, 95% CI (1.2-2.7)) and the likelihood of having high risk adenomas or cancer was higher in group HD compared with the IBS group (OR 1.6, 95% CI (1.2-2.1)) and the FH group although this was not significant (OR 1.6, 95% CI (0.97-2.6) (p=0.081); 90% CI (1.03-2.4)). After age and sex adjustment, the likelihood of having an adenoma with high grade dysplasia or cancer was higher in group HD than in the IBS group (OR 1.7, 95% CI (1.02-2.8)) or group FH, although this was not significant (OR 3.7, 95% CI (0.98-15) (p=0.076); 90% CI (1.10-12.47)). CONCLUSION: In patients with at least one colorectal adenoma, excessive alcohol consumption increases the likelihood of developing high risk adenomas or colorectal cancer.     

Different risk factors for advanced colorectal neoplasm in young adults

AIM: To compare the risk of developing advanced colorectal neoplasm(ACRN) according to age in Koreans.METHODS: A total of 70428 Koreans from an occupational cohort who underwent a colonoscopy between 2003 and 2012 at Kangbuk Samsung Hospital were retrospectively selected. We evaluated and compared odds ratios(OR) for ACRN between the young-adults(YA 50 years) and in the older-adults(OA ≥ 50 years). ACRN was defined as an adenoma ≥ 10 mm in diameter, adenoma with any component of villous histology, high-grade dysplasia, or invasive cancer.RESULTS: In the YA group, age(OR = 1.08, 95%CI: 1.06-1.09), male sex(OR = 1.26, 95%CI: 1.02-1.55), current smoking(OR = 1.37, 95%CI: 1.15-1.63), family history of colorectal cancer(OR = 1.46, 95%CI: 1.01-2.10), diabetes mellitus related factors(OR = 1.27, 95%CI: 1.06-1.54), obesity(OR = 1.23, 95%CI: 1.03-1.47), CEA(OR = 1.04, 95%CI: 1.01-1.09) and low-density lipoprotein-cholesterol(OR = 1.01, 95%CI: 1.01-1.02) were related with an increased risk of ACRN. However, age(OR = 1.08, 95%CI: 1.06-1.09), male sex(OR = 2.12, 95%CI: 1.68-2.68), current smoking(OR = 1.38, 95%CI: 1.12-1.71), obesity(OR = 1.34, 95%CI: 1.09-1.65) and CEA(OR = 1.05, 95%CI: 1.01-1.09) also increased the risk of ACRN in the OA group.CONCLUSION: The risks of ACRN differed based on age group. Different colonoscopic screening strategies are appropriate for particular subjects with risk factors for ACRN, even in subjects younger than 50 years.     

Adenoma and advanced neoplasia detection rates increase from 45 years of age

BACKGROUND Colonoscopy is considered a valid primary screening tool for colorectal cancer(CRC). The decreasing risk of CRC observed in patients undergoing colonoscopy is correlated with the adenoma detection rate(ADR). Due to the fact that screening programs usually start from the age of 50, very few data are available on the risk of adenoma between 40 and 49 years. However, the incidence of CRC is increasing in young populations and it is not uncommon in routine practice to detect adenomas or even advanced neoplasia during colonoscopy in patients under 50 years.AIM To compare the ADR and advanced neoplasia detection rate(ANDR) according to age in a large series of patients during routine colonoscopy.METHODS All consecutive patients who were scheduled for colonoscopy were included.Exclusion criteria were as follows: patients scheduled for partial colonoscopy or interventional colonoscopy(for stent insertion or stenosis dilation).Colonoscopies were performed in our unit by a team of 30 gastroenterologists in2016. We determined the ADR and ANDR in each age group in the whole population and in the population with an average risk of CRC(excluding patients with personal or family history of advanced adenoma or cancer).RESULTS6027 colonoscopies were performed in patients with a median age of 57 years(range, 15-96). The ADR and ANDR were 28.6% and 9.7%, respectively, in the whole population. When comparing patients aged 40-44(n = 382) and 45-49 years (n = 515), a strong increase in all parameters from 45 years was observed, with the ADR rising from 9.7% in patients aged 40-44 to 21.2% between 45 and 49(P 0.001) and the ANDR increasing from 3.1% in patients aged 40-44 to 6.4% in those aged 45-49 years(P 0.03). With regard to patients aged 50-54(n = 849), a statistically significant increase in the ADR and ANDR was not observed between patients aged 45-49 and those aged 50-54 years. In the population with an average risk of CRC, the ADR and ANDR were still significantly higher in patients aged 45-49 compared with those aged 40-44 years.CONCLUSION This study shows a significant two-fold increase in the ADR and ANDR in patients aged 45 years and over.     

Diagnostic yield of upper endoscopy in Asian patients presenting with dyspepsia

BACKGROUND: Colorectal cancer occurs more frequently in older people. Because the population of aged persons is increasing, a better understanding of the characteristics of colorectal cancer with respect to age would be useful. The purpose of this study was to determine whether there is any relationship between the site of colorectal adenoma and adenocarcinoma in the colon and age. METHODS: Colonoscopy was performed (September 1995 to December 1998) on 2942 consecutive patients (1907 men, 1035 women; mean age 61 years, range 11 to 95 years) with no history of colorectal adenoma, adenocarcinoma, or inflammatory bowel disease. The occurrence of colorectal neoplasia, histologically proven as adenoma or adenocarcinoma, was analyzed for a possible association between site in the colon and patient age. RESULTS: Adenocarcinoma was found in 191 patients (196 lesions). The proportion of patients with right-sided colonic adenocarcinoma increased with patient age: < 50 years, 15% (2/13); 50 to 59 years, 21% (8/39); 60 to 69 years, 32% (18/57); 70 to 79 years, 42% (25/49); > or =80 years, 57% (16/28). The proportion of patients with right-sided adenoma did not significantly differ among age groups: < 50 years, 40% (98/246); 50 to 59 years, 41% (280/678); 60 to 69 years, 46% (459/1001); 70 to 79 years, 53% (270/508); and > or =80 years, 57% (87/152). CONCLUSION: The frequency of right-sided colon cancer increases with patient age. Hence, colonoscopy may be indicated in the elderly for colorectal cancer screening. Over half of colon carcinomas may be missed if sigmoidoscopy alone is used for screening.     

Prevalence and incidence of Type 2 diabetes and its complications 1996–2003—estimates from a Swedish population‐based study

Aims To determine the prevalence and incidence of Type 2 diabetes and its complications in Uppsala county, Sweden between 1996 and 2003. Methods Retrospective population‐based study of patients with Type 2 diabetes identified in computerized medical records at 26 county primary care centres. Prevalence and incidence of Type 2 diabetes were estimated in the population aged 30–39, 40–49, 50–59, 60–69, 70–79 and ≥ 80 years. Mortality, prevalence and incidence of complications in patients with Type 2 diabetes were determined through linkage to national inpatient, uraemia and cause‐of‐death registers. Results Crude prevalence of Type 2 diabetes increased from 2.2 to 3.5% between 1996 and 2003. In the population aged ≥ 30 years, the age‐ and sex‐adjusted period increase was 53%[odds ratio (OR) 1.53, 95% confidence interval (CI) 1.47–1.58]. Crude population incidence was approximately stable after 1997 (3.7 cases/1000 residents in 1997 compared with 3.8/1000 in 2003). Age‐ and sex‐adjusted mortality rates in Type 2 diabetic patients decreased by 4% per year (OR 0.96, 95% CI 0.94–0.97). Prevalence rates of cardiovascular disease in Type 2 diabetic patients were essentially stable, affecting 13.8% of females and 18.0% of males in 2003. No trend was detected for prevalence of renal failure or incidence of acute myocardial infarction, stroke and amputation. Conclusions Prevalence of Type 2 diabetes increased in Uppsala county between 1996 and 2003 as a consequence of approximately stable incidence since 1997 and declining mortality. Rates of diabetes‐related complications, notably cardiovascular disease, continued to impose a substantial burden.     

Diabetes mellitus increases risk for colorectal adenomas in younger patients

AIM:To determine if diabetes mellitus(DM)is associated with increased risk of colorectal adenomas in younger subjects.METHODS:This was a retrospective cohort study of375 patients undergoing index colonoscopy at a single tertiary care center in the United States.Three cohorts of patients matched for exam date and gender were compared:(1)ages 40-49 years with DM;(2)ages40-49 years without DM;and(3)ages 50-59 years without DM.Data collected included demographics,co-morbidities,colonoscopy and pathology results.Adenoma detection rates(ADR)were calculated and compared.Conditional logistic regression analysis was performed to determine the association between each cohort and ADR.RESULTS:One hundred and twenty-five patients ages40-49 with DM met study eligibility criteria.Patients in the other two cohorts were randomly selected,match-ing for date of exam and gender.ADR was 14.4%in those ages 40-49 years without DM,30.4%in those ages 40-49 years with DM,and 32.0%in those ages50-59 years without DM.Compared to those ages40-49 years without DM,ADR was higher in those ages40-49 years with DM(OR=3.1;95%CI:1.5-6.4;P=0.002)and those ages 50-59 years without DM(OR=2.9;95%CI:1.5-5.6;P=0.002).There was no difference between the ADR in those ages 40-49 years with DM and those ages 50-59 years without DM(P=0.83).CONCLUSION:DM was associated with higher risk of colorectal adenomas in patients ages 40-49 years.These subjects harbored as many adenomas as those at the standard screening age of 50-59 years without DM.     

Is there a role for sigmoidoscopy in symptomatic patients? Analysis of a study correlating distal and proximal colonic neoplasias detected by colonoscopy in a symptomatic population

BACKGROUND: Colonoscopy is the gold standard exam to investigate patients with colonic complaints. However, its availability is limited in developing countries. Sigmoidoscopy has been advocated as a first procedure in colorectal cancer screening strategies, in order to select those who need colonoscopy. AIM: To study the correlation between distal and proximal colonic neoplasias in symptomatic patients 50 years or older and patients 40 to 49 years old who underwent colonoscopy at a gastrointestinal endoscopy unit in 1999 and 2000 with the purpose to evaluate its role in a symptomatic population. METHODS: All colonoscopies performed in our Department in 1999-2000 were reviewed. The distal colon was defined as the colonic segment aboral to the splenic flexure. Advanced neoplasias were defined as adenomas larger than 10 millimeters and adenocarcinomas. RESULTS: Of the 2,701 colonoscopies retrieved, 1,125 were enrolled in this study. Prevalence rates for adenoma, advanced adenoma and carcinoma were 28.9%, 4.6% and 4% in the group of 830 patients 50 years or older (mean age 65 years, 491 women). The finding of one small (<10 mm) adenoma in the distal bowel doubled the likelihood of finding a proximal neoplasia (OR = 2.12, 95% CI, 1.27-3.54), and multiple (OR = 3.99, 95% CI, 1.72-9.28) or advanced (OR = 3.73, 95% CI, 1.81-7.7) adenomas increased this risk even further. Of the patients without adenoma or carcinoma in the distal colon, 1.93% had proximal advanced neoplasia. In the group of 40 to 49-year-old patients (n = 395; mean age 44.8 years, 208 women) the prevalence of adenomas (14.9%), advanced adenomas (3.4%), and carcinomas (1.7%) was lower. CONCLUSIONS: The likelihood of finding a proximal lesion is greater in patients with distal neoplasias. This likelihood is further increased when adenomas are multiple or larger than 10 mm. One out of 52 patients 50 years or older with an apparently normal distal colon has advanced proximal neoplasia. Sigmoidoscopy is not an adequate exam for symptomatic patients aged 50 years or older.     

Association between colorectal adenoma and coronary atherosclerosis detected by CT coronary angiography in Korean men; a cross-sectional study

Background: Colorectal adenoma and coronary artery disease (CAD) appear to share common risk factors, such as male gender, diabetes mellitus, smoking, and obesity. We investigated the relationship between colorectal adenoma and coronary atherosclerosis, as a risk factor for colorectal adenoma. Methods: A cross‐sectional study was conducted on Korean men who presented for a health check‐up. The subjects were 488 men (217 colorectal adenoma and 271 normal colonoscopic findings) who underwent colonoscopy and coronary computed tomography angiography (CTA) on the same day as a screening examination. Advanced colonic lesion was defined as a presence of adenoma with villous component, high‐grade dysplasia, and/or with size of ≥1 cm. CTA findings were classified as normal, mild (low‐grade atherosclerosis or <50% stenosis), and significant CAD (≥50% stenosis). Abnormal CTA findings included mild and significant CAD. Results: Patients with abnormal CTA findings were more likely to have colorectal adenoma compared with those with normal CTA findings (P < 0.005). Furthermore, presence of advanced adenoma was significantly associated with significant CAD (P < 0.01). On multivariate analyses, abnormal CTA findings (OR = 1.66, 95% CI: 1.14–2.41, P < 0.01) and significant CAD (OR = 1.96, 95% CI: 1.15–3.35, P < 0.05) were found to be independent risk factors for colorectal adenoma after adjusting for age, current smoking, and metabolic syndrome. Conclusions: In this study, in the population who underwent CTA and colonoscopy for health check‐up, prevalence of colorectal adenoma was greater in subjects with low‐grade coronary atherosclerosis or significant CAD. The presence of advanced adenoma was significantly associated with significant CAD.     

Risk factors for colorectal adenomas among immediate family members of patients with colorectal cancer in Taiwan: a case-control study

OBJECTIVES: The incidence of colorectal cancer or adenoma among first-degree relatives of patients with colorectal cancer is significantly high. However, a well defined screening and surveillance consensus has not been developed for these families in Taiwan. We conducted this study to evaluate the colorectal adenoma prevalence pattern in screened immediate family members in Taiwan, and to derive implications for future screening programs. METHODS: A total of 234 immediate family members (aged 51.6 +/- 21.5 yr) of 186 patients with colorectal cancer were offered a colonoscopy. Each relative examined was then paired with two control subjects for age, sex, and symptoms. The prevalence of colorectal adenomas was then compared using multiple logistic regression analysis. RESULTS: The estimated risk of developing adenomas among immediate family members of patients with colorectal cancer was significantly increased (OR = 2.33; 95% CI, 1.43-3.78; p < 0.001). This trend was more striking for men (OR = 2.46; 95% CI, 1.40-4.31; p = 0.001). Immediate family members were at an increased risk for high-risk adenomas (> or = 1.0 cm, with a villous component, and/or with severe dysplasia) (OR = 4.5; 95% CI, 1.91-10.60; p = 0.002), and developed adenomas at an earlier age than did controls. Individuals with index cancer relatives diagnosed at < 50 yr of age or male relatives posed a higher risk of developing colorectal adenomas. CONCLUSIONS: The prevalence of colorectal adenoma in persons with a colorectal cancer family history in Taiwan is similar to that reported in Western countries. This high-risk population should be offered a screening colonoscopy beginning at 40 yr of age.     

Epidemiology of polyps in the rectum and sigmoid colon. Discriminant analysis for identification of individuals at risk of developing colorectal neoplasia

In an endoscopic population screening examination for detection of colorectal polyps among 324 men and women aged 50-59 years, adenomas greater than or equal to 5 mm in diameter were found in 38 individuals, and 212 were polyp-free. Dietary registration was performed by 155 individuals on a case/control basis. At 2 years' follow-up study polyps less than 5 mm in diameter were also removed. This rendered a total of 39 adenoma patients and 59 polyp-free individuals available for a combined analysis of both case history and dietary information. Application of a linear discriminant model on the combined clinical and dietary information enabled us to select a possible set of variables to characterize 88 out of 98 individuals (90%) correctly as adenoma patients or polyp-free individuals. However, when only case history information was used for the total material of 38 adenoma patients and 212 polyp-free individuals, only 189 out of 250 individuals (76%) were correctly classified. Although age, smoking habits, and a family history of colorectal cancer appeared as useful variables in the discriminant function, this study demonstrated the importance of nutritional factors in characterization of adenoma patients in the present age group of 50-59 years. In the present study we could not find any set of case history information which could indicate the usefulness of a questionnaire-based 'pre-screening' to guide recommendations for endoscopic screening examination.     

人群脉压与心脑血管病发病的研究

目的：探讨人群中脉压（PP）与心脑血管病发病的危险因素、不同PP水平与心脑血管病发病的关系。方法：（1）研究对象：对福建省8个高血压防治点1991年时年龄≥40岁的对象进行8年跟踪随访,共随访9612人（男4748人,女4864人）,应达率为92.3%;（2）基线调查内容：一般情况、吸烟史、饮酒史、心脑血管既往史,测量血压、身高、体重等;随访内容：急性心肌梗死（AMI）与脑卒中史、发病与死亡。PP分为〈30mm-Hg、30～39mmHg、40～49mmHg、50～59mmHg、60～69mmHg和≥70mmHg6组。结果：（1）人群中不同年龄组PP存在明显差异（P〈0.01）,年龄与PP呈正相关关系（r=0.465,P〈0.01）。随体重指数增高PP随之升高（P〈0.05）。既往有脑卒中史者PP明显大于无脑卒中史者（P〈0.01）;（2）进入与PP有关的回归方程的因素按标准偏回归系数大小依次为：年龄（0.467）,体重指数（0.083）,脑卒中（0.077）,性别（0.079）,吸烟史（0.035）,P值除吸烟史=0.002外,余均=0.000;（3）AMI：8年中AMI发病率为0.8%,脑卒中发病率为4.1%,脑卒中的发病是AMI的5.6倍;无论是AMI或是脑卒中的发病率,在PP≥40mmHg各组均随PP升高而升高（P〈0.01）,尤其在脑卒中发病中更明显（P〈0.01）。PP在30～39mmHg组两种疾病的发病率最低。结论：本研究提示年龄、性别、体重指数、既往脑卒中史等因素与PP水平有密切关系。急性心肌梗塞、脑卒中的发病在PP≥40mmHg随PP增高而升高,尤其是脑卒中的发病;在30～39mmHg组发病率最低。PP是心脑血病的发病重要危险因素,PP的理想水平为30～39mmHg。     

Prevalence of gastroesophageal reflux disease in a general population in Taiwan

Background and Aim: To evaluate the prevalence and risk factors of gastroesophageal reflux disease (GERD) in a general population in Taiwan. Methods: A validated symptom questionnaire, the Chinese GERD questionnaire, was utilized to determine the prevalence of GERD within a community in Taiwan. A cut‐off value for GERD diagnosis was a total score ≥12. Additionally, demographic data, including sex, age, body mass index, and consumption of tobacco and alcohol, were recorded, and a logistic regression analysis was conducted to search the independent risk factors for the development of GERD in a general population. Results: In total, 1238 residents were recruited for this study. The monthly frequencies of heartburn, epigastric acidic discomfort, and acid regurgitation were 4.4%, 3.7%, and 2.9%, respectively. The GERD prevalence was 25% in the community. The multivariate analysis showed that female sex and age of 40–49 years and 50–59 years were independent risk factors related to the development of GERD, with odd ratios of 1.71, 3.65, and 2.41, respectively (95% confidence intervals: 1.26–2.34, 1.62–8.21, and 1.11–2.54, respectively). Conclusions: GERD has become a common disorder in the general population in Taiwan. Female sex and age of 40–49 years and 50–59 years are risk factors for the development of GERD within a community.     

Interactive effects of age and other risk factors on long-term survival after coronary artery surgery

The effect of age at the time of coronary artery bypass graft surgery on postoperative survival was studied in 2,507 patients with significant coronary artery disease. Patients were subdivided into five groups based on age at the time of surgery: 20 to 39, 40 to 49, 50 to 59, 60 to 69 and greater than or equal to 70 years. The observed death rate was compared with that expected for subjects from the general U.S. population matched for age, gender, race and calendar year. For patients less than or equal to 59 years of age, the ratio of observed to expected death rates was significantly greater than unity (observed/expected = 4.9 for ages 20 to 39, 1.9 for ages 40 to 49 and 1.3 for ages 50 to 59 years, p less than 0.01). The prevalence of risk factors, including diabetes mellitus, hypertension, hypercholesterolemia and cigarette smoking, was evaluated in the different age subgroups. When patients were subdivided on the basis of history of cigarette smoking, the decreased relative survival rate of younger (less than 60 years old) patients existed only in those who smoked (observed/expected = 6.0 for ages 20 to 39, 2.2 for ages 40 to 49 and 1.4 for ages 50 to 59 years). In nonsmokers, observed/expected ratios for every age group were not significantly different from unity. Thus, the reduced relative survival rate of younger patients after coronary artery bypass graft surgery may be attributed to the interactive harmful effects of cigarette smoking.     

Incidence of arterial hypertension in Kabarda-Balkaria and the experience with its prevention among automobile transport workers]

Cross-sectional studies covered 2562 males (a urban population), 580 miners, 1126 agricultural drivers, 682 rural habitants and 4323 urban drivers. The mean blood pressures were basically identical in males of various occupations and age, except for urban and rural drivers aged 20-29 and 40-49 years who had significantly lower mean systolic blood pressures than those from the other groups under study. All the males showed elevation in systolic and diastolic blood pressures with age; the differences in blood pressures were insignificant only in rural drivers aged 30-39 and 40-49 years and miners aged 40-49 and 50-59 years. The incidence of arterial hypertension increased with age: from 3.2 to 7.7% in 20-29-year-old males to 34.2-37.2% in 50-59-year olds. Low (less that 50%) awareness of hypertension was identified in hypertensives. A prospective 5-year follow-up and implementation of prophylactic measures at the urban motor enterprises positively affected the incidence of hypertension and the level of hypertension awareness, and morbidity rates.     

不同年龄段急性冠状动脉综合征患者的危险因素、冠状动脉病变特点及预后分析

目的探讨不同年龄段急性冠状动脉综合征（ACS）患者的危险因素、冠状动脉病变特点及预后。方法DESIRE为单中心回顾性注册研究,纳入接受经皮冠状动脉介入治疗或冠状动脉旁路移植术的血运重建治疗的6005例患者。本研究从中选择ACS患者4865名,分为年龄〈40岁组135名、40～49岁组738名、50～59岁1329名、60～75岁2425名、〉75岁238名,回顾性分析其危险因素、冠状动脉病变特点及主要不良心脑血管事件（MACCE）发生率。结果ACS患者中以男性为主（男女之比为77.1%比22.9%,P〈0.05）,其中女性患者比例在50～59岁组（18.3%）、60～75岁组（30.6%）、年龄〉75岁组（28.6%）比〈40岁组（3.05%）、40～49岁组（7.5%）明显增加。50～59岁组、60～75岁组、年龄〉75岁组患者以不稳定型心绞痛为主,而年龄〈40岁组以急性ST段抬高心肌梗死多见。年龄〈40岁组、40～49岁组患者多与吸烟、低高密度脂蛋白胆固醇水平、冠心病家族史有关 50～59岁组、60～75岁组及年龄〉75岁组患者多与高血压、糖尿病有关。此外在60～75岁组及年龄〉75岁组患者中血肌酐明显升高、血红蛋白显著下降,并且与其他各组间差异有统计学意义。冠状动脉病变支数随年龄增加而增加,且除60～75岁组（2.18±0.81支）与〉75岁组（2.23±0.81支）之间差异无统计学意义外,其他各组（〈40岁组1.67±0.81支,40～49岁组1.86±0.84支,50～59岁组2.04±0.85支）间差异有统计学意义。年龄〉75岁组更多见到开口病变（12.2%）。年龄〈40岁组及年龄〉75岁组的血运重建类型差异无统计学意义。不同年龄组患者血运重建成功率差异无统计学意义。但年龄〉75岁组患者完全血运重建率较低（66.8%）,与其他各组（〈40岁组81.5%,40～49岁组81.7%,50～59岁组78.7%,60～75岁组74.3%）相比,差异均有统计学意义（P均〈0.001）。年龄〉75岁组患者院内MACCE为5.0%,与