Daily intake of magnesium and calcium from drinking water in relation to myocardial infarction

BACKGROUND: A decreased risk for cardiovascular disease has been related to the hardness of drinking water, particularly high levels of magnesium. However, the evidence is still uncertain, especially in relation to individual intake from water. METHODS: We used data from the Stockholm Heart Epidemiology Program, a population-based case-control study conducted during 1992-1994, to study the association between myocardial infarction and the daily intake of drinking water magnesium and calcium. Our analyses are based on 497 cases age 45-70 years, and 677 controls matched on age, sex, and hospital catchment area. Individual data on magnesium, calcium, and hardness of the domestic drinking water were assessed from waterwork registers or analyses of well water. RESULTS: After adjustment for the matching variables and smoking, hypertension, socioeconomic status, job strain, body mass index, diabetes, and physical inactivity, the odds ratio for myocardial infarction was 1.09 (95% confidence interval = 0.81-1.46) associated with a tap water hardness above the median (>4.4 German hardness degrees) and 0.88 (0.67-1.15) associated with a water magnesium intake above the median (>1.86 mg/d). There was no apparent sign of any exposure-response pattern related to water intake of magnesium or calcium. CONCLUSIONS: This study does not support previous reports of a protective effect on myocardial infarction associated with consumption of drinking water with higher levels of hardness, magnesium, or calcium.     

2012—2018年重庆市急性心肌梗死发病死亡趋势分析

目的了解重庆市急性心肌梗死(AMI)发病与死亡流行趋势,为开展AMI防治提供建议。方法2012—2018年重庆市AMI个案资料来源于重庆市心脑血管疾病监测数据库。根据国际疾病分类编码(ICD-10)进行疾病分类,AMI编码为I21-I22。采用SPSS 25.0软件计算发病率、标化发病率、死亡率和标化死亡率。率的比较采用χ²检验,率的趋势变化分析采用年度变化百分比(APC)。结果重庆市AMI发病率与标化发病率分别由2012年的29.86/10万、24.52/10万上升至2018年的52.67/10万、39.56/10万,APC分别为12.41%与11.18%,变化趋势均有统计学意义(P<0.01)。2012—2018年AMI发病率男性均高于女性(P<0.01)。2014年AMI发病率城市高于农村,2015—2018年AMI发病率农村高于城市(P<0.01)。农村地区AMI发病率与标化发病率分别以年均15.37%与14.34%的比例上升,变化趋势均有统计学意义(P<0.01)。2012年重庆市AMI死亡率与标化死亡率分别为20.05/10万、16.37/10万,2018年AMI死亡率与标化死亡率分别为37.49/10万、27.73/10万,变化趋势均无统计学意义(P>0.05)。2012年、2013年与2018年AMI死亡率男性高于女性(P<0.05,P<0.01)。2012年与2013年AMI死亡率城市高于农村,2015年后农村高于城市,差异均有统计学意义(P<0.01)。农村地区AMI死亡率与标化死亡率分别以14.34%、12.41%的比例上升,变化趋势均有统计学意义(P<0.05,P<0.01)。结论重庆市AMI发病率与死亡率较高,并呈快速上升的趋势,男性与农村居民是AMI防治的重点人群。     

Occupational exposure to noise and mortality from acute myocardial infarction

BACKGROUND: Exposure to noise is highly prevalent in the workplace, and an etiologic association with cardiovascular disease has been hypothesized. Although there is evidence of hypertension among noise-exposed workers, evidence of heart disease has been less conclusive. METHODS: We identified a cohort of 27,464 blue-collar workers from 14 lumber mills in British Columbia who worked at least 1 year between 1950 and 1995 and who were followed up over the same period. Cumulative noise exposure was quantitatively assessed. Vital status was ascertained from the Canadian Mortality Database. We estimated standardized mortality ratios using the general population as referents, and we estimated relative risks using an internal low-exposure group as controls. To examine acute effects of noise, we assessed relative risks during subjects' working years in lumber mills. Because of the possibility of exposure misclassification as a result of hearing-protector use, we investigated a subgroup that had been employed before widespread use of protectors. RESULTS: During the follow-up period, 2510 circulatory disease deaths occurred. Relative risks for acute myocardial infarction mortality were elevated in the full cohort, with a stronger association in the subgroup without hearing protection. There was an exposure-response trend, with a relative risk in the highest exposed group of 1.5 (95% confidence interval=1.1-2.2). The highest relative risks (2.0-4.0) were observed during subjects' working years. Smoking did not appear to confound these associations. CONCLUSIONS: Chronic exposure to noise levels typical of many workplaces was associated with excess risk for acute myocardial infarction death. Given the very high prevalence of excess noise exposure at work, this association deserves further attention.     

Magnesium and calcium in drinking water and cardiovascular mortality

Data on the hardness of drinking water were collected from 27 municipalities in Sweden where the drinking water quality had remained unchanged for more than 20 years. Analyses were made of the levels of lead, cadmium, calcium, and magnesium. These water-quality data were compared with the age-adjusted mortality rate from ischemic heart and cerebrovascular disease for the period 1969-1978. Lead and cadmium were not present in detectable amounts except in one water sample. A statistically significant inverse relationship was present between hardness and mortality from cardiovascular disease for both sexes. Mortality caused by ischemic heart disease was inversely related to the magnesium content, particularly for the men (P less than 0.01). The rather small set of data supports results from previous studies suggesting that a high magnesium level in drinking water reduces the risk for death from ischemic heart disease, especially among men, although the possible importance of confounding factors needs further evaluation.     

Calcium and magnesium in drinking water and risk of death from acute myocardial infarction in Taiwan

Many studies have examined the association between cardiovascular disease mortality and water hardness. However, the results have not been consistent. This report examines whether calcium and magnesium in drinking water are protective against acute myocardial infarction (AMI). All eligible AMI deaths (10,094 cases) of Taiwan residents from 1994 to 2003 were compared with deaths from other causes (10,094 controls), and the levels of calcium and magnesium in drinking water of these residents were determined. Data on calcium and magnesium levels in drinking water throughout Taiwan have been obtained from the Taiwan Water Supply Corporation. The control group consisted of people who died from other causes and the controls were pair matched to the cases by sex, year of birth, and year of death. The adjusted odd ratios (95% confidence interval) were 0.79 (0.73-0.86) for the group with water calcium levels between 25.1 and 42.4 mg/L and 0.71 (0.65-0.77) for the group with calcium levels of 42.6 mg/L or more. After adjustment for calcium levels in drinking water, there was no difference between the groups with different levels of magnesium. The results of the present study show that there is a significant protective effect of calcium intake from drinking water on the risk of death from AMI.     

The risk of acute myocardial infarction after stopping drinking

BACKGROUND: Subjects at high risk of alcohol-related diseases may benefit from alcohol cessation. However, drinkers have a lower risk of acute myocardial infarction (AMI) than abstainers, and there is very scanty information on how the risk changes after stopping drinking. METHODS: Between 1995 and 1999, we administered a structured questionnaire to 507 cases (378 men, 129 women) with a first episode of nonfatal AMI and 478 control patients (297 men, 181 women) admitted to the same network of hospitals in the greater Milan area for acute conditions. RESULTS: Compared to lifelong abstainers, the odds ratio (OR) adjusted for age, sex, and several AMI risk factors was 0.56 (95% confidence interval [CI] 0.41-0.84) for current and 0.65 (95% CI 0.37-1.15) for former drinkers (48 cases and 44 controls). The OR was 2.10 (0.40-11.1) for having stopped since 1 year, 0.64 (95% CI 0.19-2.16) for 2-4 years, 0.46 (95% CI 0.18-1.20) for 5-14 years, and 0.78 (95% CI 0.27-2.27) for > or = 15 years. CONCLUSIONS: Although our data are too limited to draw any definite conclusion, they suggest that the protection of alcohol drinking against AMI may persist, at least in part, for several years after stopping.     

Infant mortality in Brazil and deaths from acute myocardial infarction in the same generation

Low birth weight is a risk factor for cardiovascular diseases, which constitute the main causes of death both in Brazil and worldwide. High infant mortality rates are associated with low birth weight. The aim of this study was to compare mortality from acute myocardial infarction in 2000 in the Northeast and South of Brazil, regions with different infant mortality rates from 1930 to 1950. Mortality from acute myocardial infarction was higher in southern Brazil, with an adjusted coefficient per 100,000 of 60.8 in males and 41.2 in females (South) versus 26.4 in males and 19.2 in females (Northeast). Similar results were found for lung cancer: 22.8 in males and 8.9 in females (South) versus 5.3 in males and 2.8 in females (Northeast). The persistence of different socioeconomic conditions and infant mortality rates between the two regions and the fact that the phenomenon of infant mortality reduction in Brazil has not been translated into important improvements in quality of life impeded an evaluation of the impact of low birth weight on mortality from acute myocardial infarction in this study.     

Market reform in New Jersey and the effect on mortality from acute myocardial infarction

OBJECTIVE: To determine whether mortality rates for patients with acute myocardial infarction (AMI) changed in New Jersey after implementation of the Health Care Reform Act, which reduced subsidies for hospital care for the uninsured and changed hospital payment to price competition from a rate-setting system based on hospital cost. DATA SOURCES/STUDY SETTING: Patient discharge data from hospitals in New Jersey and New York from 1990 through 1996 and the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS). STUDY DESIGN: A comparison between states over time of unadjusted and risk-adjusted mortality and cardiac procedure rates. DATA COLLECTION: Discharge data were obtained for 286,640 patients with the primary diagnosis of AMI admitted to hospitals in New Jersey or New York from 1990 through 1996. Records of 364,273 NIS patients were used to corroborate time trends. PRINCIPAL FINDINGS: There were no significant differences in AMI mortality among insured patients in New Jersey relative to New York or the NIS. However, there was a relative increase in mortality of 41 to 57 percent among uninsured New Jersey patients post-reform, and their rates of expensive cardiac procedures decreased concomitantly. CONCLUSIONS: The introduction of hospital price competition and reductions in subsidies for hospital care of the uninsured were associated with an increased mortality rate among uninsured New Jersey AMI patients. A relative decrease in the use of cardiac procedures in New Jersey may partly explain this finding. Additional studies should be done to identify whether other market reforms have been associated with changes in the quality of care.     

Stroke and acute myocardial infarction in the Swedish Sami population: incidence and mortality in relation to income and level of education

BACKGROUND: Gender differences in cardiovascular diseases (CVD) among the Sami have been reported previously. The aim of the present study was to investigate the incidence of and mortality from stroke, subarachnoid haemorrhage (SAH), and acute myocardial infarction (AMI) in the Swedish Sami population between 1985 and 2002, and to analyse the potential impact of income and level of education on cardiovascular morbidity and mortality. METHODS: A Sami cohort of 15,914 persons (4,465 reindeer herding and 11,449 non-herding Sami) were followed up from 1985 to 2002 with regard to incidence and mortality rates of AMI, stroke, and SAH. Incidence and mortality ratios were calculated using a demographically matched non-Sami control population (DMC) as the standard (71,550 persons). RESULTS: There was no elevated risk of developing AMI among the Sami compared with the DMC. However, the mortality ratio of AMI was significantly higher for Sami women. Higher incidence rates of stroke and SAH for both Sami men and women was observed, but no differences in mortality rates. Apart from the reindeer-herding men who demonstrated lower levels of income and education, the income and education levels among Sami were similar to the DMC. CONCLUSIONS: High mortality rates from AMI rather than stroke explain the excess mortality for CVD previously shown among Sami women. The results suggest that the differences in incidence of stroke between herding and non-herding Sami men, and between Sami women and non-Sami women, are caused by behavioural and psychosocial risk factors rather than by traditional socioeconomic ones.     

Socioeconomic status and mortality after acute myocardial infarction: a study from Iran

Background  

Studies have shown an inverse relationship between socioeconomic status (SES) and mortality due to coronary heart disease (CHD). Little is known about this association in Iran. This study aimed to investigate whether mortality after myocardial infarction (MI) varies by SES.     

天津市2007-2015年急性心肌梗死死亡发病比变化趋势分析

目的 分析2007-2015年天津市急性心肌梗死（AMI）死亡发病比的变化规律。方法 收集2007-2015年天津市AMI的发病监测数据和死因登记数据，计算≥ 35岁人群分性别的AMI发病率及死亡率，用指数曲线拟合标化发病率和标化死亡率的变化趋势，再计算各年AMI的死亡发病比，并用Joinpoint软件对AMI死亡发病比进行敏感性分析。结果 除2007、2010、2014和2015年AMI死亡发病比<1.00以外，其余年份死亡发病比均>1.00。2007-2015年女性AMI死亡发病比为0.90~1.80，男性死亡发病比为0.80~1.40，合计死亡发病比为0.80~1.60。结论 2007-2015年天津市AMI死亡发病比的变化相对平稳，但AMI发病监测系统可能存在一定漏报，>75岁年龄组AMI死亡发病比>1.00，提示该年龄人群AMI发病漏报明显。     

Tomato intake in relation to mortality and morbidity among Sudanese children

The intake of foods that contain high levels of antioxidants may counteract the adverse effects of oxidative stress and lead to improved immune function and reduced risk of infectious disease. We prospectively examined the relationship between the consumption of tomatoes, a rich source of antioxidants, and mortality and diarrheal and respiratory morbidity rates among 28,753 children who were 6-60 mo old and enrolled in a longitudinal study in the Sudan. Children in each household were visited every 6 mo for a maximum of four visits. At each round, mothers recalled whether a child had consumed tomatoes in the previous 24 h. Events (death or morbidity) reported at each round were prospectively allocated according to the number of days of tomato intake. Intake of tomatoes for 2 or 3 d compared with none was associated, respectively, with 48% (relative risk, 0. 53; 95% confidence interval, 0.30-0.91) and 83% (0.17; 0.04-0.72) reductions in morality rates (P: for trend = 0.002). The association between tomato use and death remained statistically significant (P: for trend = 0.004), even after further adjustment for total vitamin A intake. Tomato intake was also associated with a reduced risk of death associated with diarrhea in the week preceding death (P: for trend = 0.009) or fever (P: for trend = 0.04). Intake of tomatoes was also inversely and significantly associated with the risks of diarrheal and respiratory infections. Our data suggest that tomatoes may be beneficial for child health but also emphasize the general importance of food-based approaches to the prevention of micronutrient malnutrition and protection of the health of children in developing countries.     

The relation between socioeconomic status and short-term mortality after acute myocardial infarction persists in the elderly: results from a nationwide study

We assessed whether the previously observed relationship between socioeconomic status (SES) and short-term mortality (pre-hospital mortality and 28-day case-fatality) after a first acute myocardial infarction (AMI) in persons <75?years, are also observed in the elderly (i.e. ≥75?years), and whether these relationships vary by sex. A nationwide register based cohort study was conducted. Between January 1st 1998 and December 31st 2007, 76,351 first AMI patients were identified, of whom 60,498 (79.2?%) were hospitalized. Logistic regression analyses were performed to measure SES differences in pre-hospital mortality after a first AMI and 28-day case-fatality after a first AMI hospitalization. All analyses were stratified by sex and age group (<55, 55-64, 65-74, 75-84, ≥85), and adjusted for age, ethnic origin, marital status, and degree of urbanization. There was an inverse relation between SES and pre-hospital mortality in both sexes. There was also an inverse relation between SES and 28-day case-fatality after hospitalization, but only in men. Compared to elderly men with the highest SES, elderly men with the lowest SES had a higher pre-hospital mortality in both 75-84?year-olds (OR?=?1.26; 95?% CI 1.09-1.47) and ≥85?year-olds (OR?=?1.26; 1.00-1.58), and a higher 28-day case-fatality in both 75-84?year-olds (OR?=?1.26; 1.06-1.50) and ≥85?year-olds (OR?=?1.36; 0.99-1.85). Compared to elderly women with the highest SES, elderly women with the lowest SES had a higher pre-hospital mortality in ≥85?year-olds (OR?=?1.20; 0.99-1.46). To conclude, in men there are SES inequalities in both pre-hospital mortality and case-fatality after a first AMI, in women these SES inequalities are only shown in pre-hospital mortality. The inequalities persist in the elderly (≥75?years of age). Clinicians and policymakers need to be more vigilant on the population with a low SES background, including the elderly.     

Spatial distribution of mortality from acute myocardial infarction in Rio de Janeiro, Brazil

The study analyzes the spatial distribution of mortality from acute myocardial infarction (AMI) in Rio de Janeiro, Brazil. Data from the Mortality Information System refers to the year 2000. Empirical Bayes smoothing technique was used to minimize random variation in mortality coefficients due to the population size in the geographic analytical units. Spatial distribution of AMI mortality in the city of Rio de Janeiro is heterogeneous and displays a pattern associated with a strong socioeconomic gradient. The decreased AMI risk in the West Side of the city fails to reflect the social inequality and limited access to healthcare services observed there. A more likely hypothesis is that the risk of AMI death was underestimated in the West Side, due to the high proportion of ill-defined causes of death in that region. In the rest of the city, the spatial pattern of AMI mortality showed higher values in poorer areas. The various hospitals treating AMI also show a clear pattern in their areas of influence.     

Effect of a coronary care unit on mortality from acute myocardial infarction.

The mortality from acute myocardial infarction was compared for 2 years before the introduction of a coronary care unit (C.C.U.), and three and a half years after. The difference was not significant statistically (18% before, and 15% after). There was no reduction in the incidence of cardiac arrest in the C.C.U. period, but resuscitation from cardiac arrest was more successful. The results are considered in the light of previous studies, and the current status of coronary care in district general hospitals is discussed.     

厦门市城乡居民急性心肌梗死死亡的比较研究

目的比较厦门市城乡居民急性心肌梗死死亡和变化趋势,为厦门市急性心肌梗死预防控制工作提供依据。方法收集2003—2014年厦门市城乡居民急性心肌梗死死亡资料,用死亡率、死亡率年均变化百分比(annual percentage change,APC)等指标进行评价。结果 2003—2014年厦门市居民因急性心肌梗死死亡6 507例,死亡率为31.84/10万,标化死亡率(standardized mortality rate,SMR)为31.89/10万;其中城市死亡3 480例,死亡率为25.61/10万,SMR为26.90/10万;农村死亡3 027例,死亡率为42.05/10万,SMR为38.54/10万。随着年龄的增长,死亡率逐渐升高,在85岁以上年龄组达到高峰,峰值分别为886.04/10万和1 177.75/10万。时间变化趋势检验显示,厦门市居民急性心肌梗死死亡率仍维持在较平稳水平。结论厦门市城乡居民急性心肌梗死死亡率均居高不下,应以男性、老年人群为重点防治对象,重视急性心肌梗死防治工作。     

Estimating out-of-hospital mortality due to myocardial infarction

We developed a model to estimate out-of-hospital deaths due to Myocardial Infarction (MI), which was based on a detailed database of MI admissions to Pennsylvania hospitals during 1998. Our estimation method addresses the problem of geographical selection bias in inpatient databases, which occurs when MI patients with poor geographic access are undersampled. A Geographic Information System (GIS) was used to determine travel times between hospitals and patients, based on patients' zip code of residence. Nearness to a hospital was positively associated with in-hospital mortality (P<0.01) and emergency admissions (P<0.01) and negatively associated with out-of-hospital mortality (P<0.01). Model predictions were made for a range of input values and validated using empirical data.