Family history of ischemic heart disease with respect to mean twin-pair cholesterol and subsequent ischemic heart disease in the NHLBI twin study

This study examines the independent and interactive effects of family history scores (FHxS) for the prevalence of ischemic heart disease with plasma lipids and subsequent morbidity and mortality from ischemic heart disease. FHxS were calculated for 514 sets of middle aged male twins who participated in the entry examination of the NHLBI Veteran twin study in 1969-1973. Comparison of the FHxS with the level of plasma total cholesterol and HDL cholesterol (HDLc) paralleled earlier reported findings in young adults; individuals with high total cholesterol in two exams 8-12 years apart had significantly (P less than .01) higher FHxS. The same relationship was noted when using the mean twin-pair cholesterol level at the initial exam when the twins were in their 40s. Using the pair means over two exams as the cotwins aged into their 50s, the association of FHxS with total cholesterol declined and pairs with HDLc persistently in the highest quintile at both exams had significantly (P less than .01) lower FHxS. The changes in the pattern of association of lipid fractions with FHxS with age parallel the reported age decline of total cholesterol as a risk factor for heart disease. Assessment of ischemic heart disease events up to January 1988 revealed a highly significant association (P less than .0001) of later ischemic heart disease events with FHxS. At each level of lipid categorization pairs who later had events had higher FHxS than those without any subsequent heart disease; these differences were significant in all but the low risk lipid groups (low total cholesterol, high HDLc, and low total cholesterol/HDLc ratio). We conclude that FHxS is related to total cholesterol and HDLc but also is an independent predictor of subsequent ischemic heart disease after 14-18 years of follow-up.     

The NHLBI twin study of cardiovascular disease risk factors: methodology and summary of results

Coronary heart disease (CHD) risk factors were studied in 250 monozygotic (MZ) and 264 dizygotic (DZ) male veteran twin pairs, aged 42-56. All coronary heart disease risk factors studied showed significant correlations in both MZ and DZ twins. Substantial genetic variation was detected for height, blood pressure, glucose intolerance, uric acid, plasma triglyceride, and relative weight but little or no significant genetic variability in low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), total plasma cholesterol or hematocrit was demonstrable. These findings suggest that familial aggregation results from genetic influence on blood pressure, glucose intolerance, uric acid, triglyceride and, possibly, obesity, while largely shared environmental factors contribute to familial similarities in HDL, LDL, total cholesterol and hematocrit.     

Neurobehavioral functioning after cessation of manganese exposure: a follow-up after 14 years

BACKGROUND: Little is known on the long-term course of early manganese (Mn) neurotoxic effects. Mn alloy workers were examined in a follow-up study 14 years after exposure ceased at a Canadian facility. METHODS: The same battery of neurofunctional tests used in the initial examination in 1990 was administered to 77 Mn-workers and 81 referents in 2004. RESULTS: Manganese-workers had poorer scores compared to referents both in the initial and follow-up examinations for several motor tasks of the Luria Motor Scale. At follow-up, older Mn-workers (>45 years at cessation of exposure) had poorer scores than referents for tests of cognitive flexibility. Cumulated exposure was associated with poorer test scores for certain neuromotor and cognitive tests and on a mood scale. Differences on certain tests observed at initial examination were not present at follow-up. CONCLUSIONS: Manganese exposure was associated with persistent deficits for certain neuromotor functions, cognitive flexibility, and adVerse mood states, while recovery occurred for other functions.     

Rheumatic heart disease: 15 years of clinical and immunological follow-up

Rheumatic fever (RF) is a sequel of group A streptococcal throat infection and occurs in untreated susceptible children. Rheumatic heart disease (RHD), the major sequel of RF, occurs in 30%-45% of RF patients. RF is still considered endemic in some regions of Brazil and is responsible for approximately 90% of early childhood valvular surgery in the country. In this study, we present a 15-year clinical follow-up of 25 children who underwent surgical valvular repair. Histopathological and immunological features of heart tissue lesions of RHD patients were also evaluated. The patients presented severe forms of RHD with congestive symptoms at a very young age. Many of them had surgery at the acute phase of RF. Histological analysis showed the presence of dense valvular inflammatory infiltrates and Aschoff nodules in the myocardium of 21% of acute RHD patients. Infiltrating T-cells were mainly CD4+ in heart tissue biopsies of patients with rheumatic activity. In addition, CD4+ and CD8+ infiltrating T-cell clones recognized streptococcal M peptides and cardiac tissue proteins. These findings may open the possibilities of new ways of immunotherapy. In addition, we demonstrated that the surgical procedure during acute phase of the disease improved the quality of life of young RHD patients.     

The pattern of ischemic heart disease 1931-1980

The rise in ischemic heart disease in the U.S. after 1920 has been described in the literature both as a 20th century epidemic and as an artifact of the decline of competing causes of death, particularly the infectious, parasitic and diarrheal diseases. Shifting medical terminology and occasional major revisions in cause of death codes have aggravated efforts to resolve the debate. Through regression analysis and ordinary and cause-deleted life tables we trace the course of the disease. The accumulated evidence points to a major epidemic but one largely confined to males. Reversals in patterns are now beginning.     

Positive psychological and life-style changes after myocardial infarction: a follow-up study after 2-4 years

An interview study of 84 males recruited from a post-infarction anticoagulant trial revealed a number of positive changes regarding life-style and factors related to quality of life 3-5 months after the index infarction. In the present study we investigated the extent to which such changes persist after 2-4 (additional) years. Seventy-four of 75 survivors responded to a postal questionnaire. The answers concerning the total life situation, as compared with the last month before the myocardial infarction, were as follows (response after 3-5 months in brackets): improved 29% (33%), unchanged/uncertain 47% (47%) and deteriorated 24% (20%). There were still appreciable positive changes at follow-up regarding smoking, physical activity, alcohol consumption and stress at work. Similar changes or a slight reduction were observed in previously reported positive scoring of factors related to quality of life. The same applied to the two General Health Questionnaire scorings. We conclude that positive changes in psychosocial and life-style factors as seen shortly after myocardial infarction generally seem to persist after 2-4 years.     

老年冠心病患者药物洗脱支架置入术后5年随访研究

目的探讨经皮冠状动脉介入术（PCI）置入雷帕霉素洗脱支架（DES）治疗高龄冠心病患者的远期疗效。方法单中心回顾性连续入选2004年1月～2006年1月在住院期间成功置入DES的102例老年冠心病患者进行随访调查,按年龄分为80～89岁组（52例）,60～79岁组（50例）。随访5年,随访包括心绞痛复发、死亡、心肌梗死、卒中和再次血运重建的主要不良心脑血管事件。结果两组PCI术成功率均为100%。随访率100%,随访5年,80～89岁组与60～79岁组术后并发症发生率（6.0%vs7.6%）、卒中发生率（3.8%vs2.0%）、心源性病死率（0%vs0%）差异无统计学意义（均P〉0.05）。80～89岁组再次血运重建率（9.6%vs24.0%）、心绞痛复发率（13.5%vs30.0%）低于60~79岁组;全因病死率（7.6%vs2.0%）高于60～79岁组。结论年龄因素对DES的疗效及安全性无明显影响,年龄〉80岁患者选择性DES安全,成功率高,远期疗效尚好。     

Dietary fat intake and risk of coronary heart disease in women: 20 years of follow-up of the nurses' health study

The authors examined the associations of dietary fat and specific types of fat with risk of coronary heart disease (CHD) among 78,778 US women initially free of cardiovascular disease and diabetes in 1980. They documented 1,766 incident CHD cases (including 1,241 nonfatal myocardial infarctions and 525 CHD deaths) during 20 years of follow-up. Polyunsaturated fat intake was inversely associated with CHD risk (multivariate relative risk (RR) for the highest vs. the lowest quintile = 0.75, 95% confidence interval (CI): 0.60, 0.92; p(trend) = 0.004), whereas trans-fat intake was associated with an elevated risk of CHD (RR = 1.33, 95% CI: 1.07, 1.66; p(trend) = 0.01). The associations between intakes of polyunsaturated fat and trans-fat with CHD risk were most evident among women younger than age 65 years (for polyunsaturated fat, RR = 0.66, 95% CI: 0.50, 0.85; p(trend) = 0.002 and for trans-fat, RR = 1.50, 95% CI: 1.13, 2.00; p(trend) = 0.01). The inverse association between polyunsaturated fat intake and CHD risk was strongest among women whose body mass index was >or=25 kg/m(2). Findings continue to support an inverse relation between polyunsaturated fat intake and CHD risk, particularly among younger or overweight women. In addition, trans-fat intake was associated with increased risk of CHD, particularly for younger women.     

Urban-rural inequalities in ischemic heart disease in Scotland, 1981-1999

OBJECTIVES: We sought to describe the pattern and magnitude of urban-rural variation in ischemic heart disease (IHD) in Scotland and to examine the associations among IHD health indicators, level of rurality, and degree of socioeconomic deprivation. METHODS: We used routine population and health data on the population aged 40-74 years between 1981 and 1999 and living in 826 small areas (average population=5600) in Scotland. Three IHD health indicators-mortality rates (deaths per 100,000 population), rates of continuous hospital stays (discharges per 100,000 population), and rates of mortality in the hospital or within 28 days of discharge (MH+) were analyzed with multilevel Poisson models. A 4-level rurality classification was used: urban areas, remote small towns, accessible rural areas, and remote rural areas. RESULTS: Rates of mortality, continuous hospital stays, and MH+ increased with area socioeconomic deprivation. After adjustment for population age, gender, and deprivation, the relative risk of IHD mortality in remote rural areas was similar to that of urban areas in 1981; the relative risk of a continuous hospital stay was significantly lower (relative risk [RR] = 0.70; 95% confidence interval [CI] = 0.64, 0.76) and the relative risk of MH+ was higher (RR=1.18; 95% CI=1.04, 1.35) in remote rural areas. Mortality and MH+ declined for all ruralities over time. However, MH+ remains highest in remote rural areas and remote towns. CONCLUSIONS: Low standardized ratios of IHD continuous hospital stays and mortality in remote rural areas mask health problems among rural populations. Although absolute and relative differences between urban and rural rates of MH+ have diminished, the relative risk of MH+ remains high in remote rural areas.     

Mortality from cancer and ischemic heart disease in Danish chimney sweeps: a five-year follow-up

A mortality study of 713 male chimney sweeps in Denmark was performed. The observed number of deaths in 1970-1975 was compared with the expected number, calculated from cohort, period, and cause-specific death rates for employed Danish males. A total of 38 deaths was observed compared with the 18.3 deaths expected (p less than 0.01). Cancer accounted for 12 deaths versus 5.3 expected (p less than 0.05), ischemic heart disease for 12 deaths versus 5.4 expected (p less than 0.05), and residual causes for 14 deaths versus 7.6 expected (p less than 0.05). The excess mortality was exclusively due to cancer and ischemic heart disease among chimney sweeps in the older age group (45-74 years), whereas a high mortality due to other causes was observed among the younger sweeps (15-44 years). It is concluded that heavy inhalation exposure to products from the combustion of fossil fuel leads to an increased individual risk of cancer and ischemic heart disease and substantially reduces the time until occurrence of these diseases.     

Mortality from ischemic heart disease in Iceland, 1951-1985.

The objective of this study was to evaluate mortality rates from ischemic heart disease among Icelanders during the period of 1951 to 1985. In some developed countries, the number of deaths from ischemic heart disease declined markedly in this time period, and it is interesting to study whether the same has occurred in Iceland. The study was based on information obtained from the Statistical Bureau of Iceland, which keeps records of deaths based on death certificates as well as other population records. Nonparametric tests were used to correlate death rates and calendar years. Rates per 100,000 were calculated and plotted. The results indicated that the mortality rates from ischemic heart disease among Icelanders have not yet peaked.     

1817名铸造厂工人缺血性心脏病的队列研究

目的研究铸造作业工人缺血性心脏病发病风险及其与铸造作业、矽尘累积接触量之间的剂量-反应关系,并对缺血性心脏病的发病风险进行预测。方法采用队列研究方法,选择某铸造厂1980年1月1日-1996年12月31日在册一年以上的铸造作业工人建立研究队列,观察终止日期为2009年12月31日。以浇注、配砂、清理、熔炼、天车、造型和制芯等工种工人作为铸造组,电工、钳工和检查工等辅助工作为对照组。使用SPSS软件Cox回归模型分析缺血性心脏病发病风险及其与铸造作业、矽尘累积接触量之间的剂量-反应关系,并使用logistic回归建立缺血性心脏病发病风险的预测模型。结果本研究共随访30年,1817人,45 553.05人年,缺血性心脏病156例,人-年发病率为342.46/10万,平均发病年龄51.46岁,发病工龄21.61年。男性、吸烟、饮酒、年龄和工龄分别都是缺血性心脏病发病的危险因素。缺血性心脏病发病风险与矽尘累积接触量呈正相关,调整吸烟的影响后,工人矽尘年累积接触量每增加1mg/m3,缺血性心脏病发病风险增加75.8%(RR=1.758,95%CI1.221～2.532)。铸造组工人缺血性心脏病发病风险显著增加,调整吸烟的影响后,与对照组工人相比,配砂工、清理工、熔炼工、造型工、制芯工分别增加1.048倍、1.395倍、70.4%、97.0%和1.270倍。根据预测模型,工人缺血性心脏病发病概率随日接触矽尘浓度的增加、接尘工龄的延长而增加。结论铸造作业工人面临较大的缺血性心脏病发病风险。不同工种工人缺血性心脏病发病风险不同,其中,配砂、清理、熔炼、造型、制芯工人较高。铸造作业、矽尘累积接触量是缺血性心脏病的独立危险因素。缺血性心脏病预测模型表明,发病概率与日接触矽尘浓度和接尘工龄呈明显的剂量-反应关系。     

Styrene exposure and ischemic heart disease: a case-cohort study

Epidemiologic studies have consistently reported increased daily mortality and hospital admissions for ischemic heart disease related to daily changes in ambient particulate levels. One theory is that substances adhering to particulates might have a cardiovascular effect. Styrene has been found in very low doses in air and has chemical characteristics that would cause adherence to particles. Industrial studies have found an increase in cardiovascular disease among styrene-exposed workers. To explore a possible dose-response relation between styrene exposure and ischemic heart disease, the authors of this case-cohort study included 498 cases that died from ischemic heart disease and a 15% random sample (n = 997) of all male workers who were employed during 1943-1984 in two styrene-butadiene rubber-manufacturing plants in the United States. Proportional hazards models showed that recent styrene exposure was significantly associated with acute ischemic heart disease death among active workers. The relative hazard of death from acute ischemic heart disease for exposure during the most recent 2 years among active workers with 2 or more years of employment was 2.95 (95% confidence interval: 1.02, 8.57) at a time-weighted styrene concentration of 0.2-<0.3 ppm and 4.30 (95% confidence interval: 1.56, 11.84) at >or=0.3 ppm for the same exposure period, respectively.     

Ten-year follow-up for male twins divided into high- or low-risk groups for ischemic heart disease based on risk factors measured 25 years previously

PURPOSE: To undertake medical follow-up in white males in the National Heart, Lung, and Blood Institute (NHLBI) twin study, previously divided on the basis of cardiovascular disease risk factors. METHODS: Tree structured survival analysis (TSSA) used at a mean age of 63 years to classify twins into high and low risk subgroups for ischemic heart disease (IHD) found that subjects at a mean age of 48 years were at highest risk with high systolic blood pressures and low high density lipoprotein cholesterol levels. Low risk subjects had lower blood pressures, better pulmonary function tests, and a negative family history for IHD or low post load plasma glucose levels. Medical record review was performed ten years later at the 4th Examination of the NHLBI twin cohort conducted in 1995-1997. RESULTS: The percentage of men in the NHLBI twin study who died nearly tripled (from 9.3% to 25.8%) in the ten-year period between the ages of 63 and 73 years. Deaths have tended to remain higher in DZ than MZ twins (27.8% versus 23.7%). At Exam 4, the relative risk of IHD (fatal or non-fatal) was 5.24 times higher for those in the high risk group than those in the low risk class (95% confidence limit 2.72-10.07, p < 0.0001 and 5.86 for any cardiovascular disease (95% confidence limit 3.03-11.33). The proportion of deaths from IHD in subjects with a high risk profile at entry was 51.7%, and 70.0% had died from all cardiovascular related disease. CONCLUSION: The present results indicate TSSA remained effective in classifying subjects into subgroups with greater risk of morbidity and mortality related to cardiovascular disease after ten additional years.     

A 3-year follow-up study of coronary heart disease in Delhi.

A follow-up study of coronary heart disease (CHD) was carried out among adults in Delhi 3 years after an initial community-based epidemiological survey of the same population. A total of 575 of the 814 cases of CHD detected clinically and by electrocardiogram (ECG) in the initial survey took part. On re-examination of the original cohort of 4151 adults who were free of CHD both clinically and by ECG in the initial survey, 245 new cases of CHD were detected - 73 on a clinical basis (21 with myocardial infarction and 52 with angina pectoris) and 172 by ECG (13 with myocardial infarction and 159 with probable CHD based on ST and T changes). The overall incidence of CHD was 19.7 per 1000 (males, 17.3 per 1000; females, 21.0 per 1000). The incidence on a clinical basis was 5.9 per 1000 (males, 6.5 per 1000; females, 5.5 per 1000) compared with 13.8 per 1000 by ECG (males, 10.8 per 1000; females, 15.5 per 1000). Although the incidence of myocardial infarction was higher in men (3.6 per 1000) than women (2.2 per 1000), the incidence of angina pectoris was 36.5% higher in women (18.7 per 1000) than in men (13.7 per 1000). Hypercholesterolaemia and systemic hypertension were the commonest risk factors in the 245 new cases.     

Four-year follow-up of the immunogenicity and safety of the HPV-16/18 AS04-adjuvanted vaccine when administered to adolescent girls aged 10-14 years

PurposeLong-term immunogenicity and safety of the human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine when administered to adolescent girls was evaluated.MethodsThis open-label, follow-up study (NCT00316706) was conducted in 31 centers in Taiwan, Germany, Honduras, Panama, and Colombia. In the initial study (NCT00196924), 1,035 girls aged 10–14 years received the HPV-16/18 AS04-adjuvanted vaccine at 0, 1, and 6 months. Here, geometric mean titers (GMTs) of antibodies against HPV-16, HPV-18, and monophosphoryl lipid A (MPL), a component of the AS04 Adjuvant System, were reported up to month 48.ResultsIn the according-to-protocol immunogenicity cohort (N = 563), GMTs at month 48 in initially seronegative participants were 2,374.9 (95% confidence interval: 2,205.7–2,557.0) EL.U/mL for anti-HPV-16 and 864.8 (796.9–938.4) EL.U/mL for anti-HPV-18, that is, six- and threefold higher than the plateau level in a reference study demonstrating vaccine efficacy in young women (age, 15–25 years). All participants remained seropositive for anti-HPV-16 and anti-HPV-18 at month 48. Most participants (81.8%) were seropositive for anti-MPL antibodies before vaccination. Anti-MPL antibody titers in initially seropositive participants increased initially, and then declined. Most initially seronegative participants for anti-MPL seroconverted; 69.6% remained seropositive at month 48, with anti-MPL antibody titers similar to the natural background level. The vaccine was generally well tolerated. No serious adverse events were considered related to vaccination.ConclusionsIn adolescent girls, the HPV-16/18 AS04-adjuvanted vaccine produces anti-HPV-16 and anti-HPV-18 antibody titers that are maintained for up to 4 years at higher levels than those in young women in whom vaccine efficacy against cervical lesions was demonstrated.