Cardiovascular risk factors. Insights from Framingham Heart Study

Epidemiology involves the study of disease frequency and its determinants within the population. Cardiovascular epidemiology began in the 1930s as a result of changes observed in the causes of death. In the 1950s, several epidemiological studies were set in motion with the aim of clarifying the cause of cardiovascular disease. Four years after the Framingham Heart Study started, researchers had identified high cholesterol and high blood pressure levels as important factors in the development of cardiovascular disease. In subsequent years, the Framingham study and other epidemiological studies have helped to identify other risk factors, which are now considered classical risk factors. By coining the expression "risk factor", the Framingham Heart Study helped to bring about a change in the way medicine is practiced. Today, a risk factor is defined as a measurable characteristic that is causally associated with increased disease frequency and that is a significant independent predictor of an increased risk of presenting with the disease. This wide-ranging overview describes some of the most important insights into the causes of cardiovascular disease to have come from the Framingham Heart Study. The emphasis is on the identification of risk factors, and the assessment of their predictive ability and their implications for disease prevention.     

Cardiovascular disease risk factors, type 2 diabetes mellitus, and the Framingham Heart Study

Type 2 diabetes is a common disorder and an important risk factor for cardiovascular disease. The Framingham Heart Study is a population-based epidemiologic study that has contributed to our knowledge of cardiovascular disease and its risk factors. This review will focus on the contemporary contributions of the Framingham Heart Study to the field of diabetes epidemiology, including data on diabetes trends, genetics, and future advances in population-based studies.     

Fatigue predicts mortality in older adults

OBJECTIVES: To determine the association between fatigue and survival over 10 years in a population of older community‐dwelling primary care patients. DESIGN: Prospective cohort study. SETTING: Medicare health maintenance organization and Veterans Affairs primary care programs. PARTICIPANTS: Older primary care patients (N=492). MEASUREMENTS: Fatigue, operationalized as feeling tired most of the time, was assessed at baseline. Mortality was ascertained from the National Death Index. Covariates included demographics, comorbidity, cognitive function, depressive symptoms, body mass index, self‐rated health, functional status, and gait speed. RESULTS: Mortality rates at 10 years were 59% (123/210) for older adults with fatigue, versus 38% (106/282) for those without fatigue (P<.001). After adjustment for multiple potential confounders, participants who were tired at baseline had a greater risk of death than those who were not (hazard ratio=1.44, 95% confidence interval=1.08–1.93). CONCLUSION: A single simple question “Do you feel tired most of the time?” identifies older adults with a higher risk of mortality. Further research is needed to identify and characterize the underlying mechanisms of fatigue, to develop and test specific treatments, and to determine whether improvement leads to decreased morbidity and mortality.     

中国多省市心血管病危险因素队列研究与美国弗莱明翰心脏研究结果的比较

目的　对比分析我国多省市心血管病危险因素队列研究 (ChineseMulti ProvincialCohortStudy ,CMCS)与美国弗莱明翰心脏研究的结果 ,探讨弗莱明翰预测模型在我国人群中的适用性。方法　分析CMCS队列 35～ 6 4岁 30 12 1人 10年的随访结果和弗莱明翰队列 30～ 74岁 5 2 5 1人的 12年随访结果 ,比较两人群 10年冠心病发病危险、基线危险因素水平、各危险因素的相对危险度以及CMCS模型和弗莱明翰模型的预测效果。结果　 (1)CMCS队列男女两性的 10年发病危险分别为1 5 %和 0 6 % ,显著低于弗莱明翰队列男女两性的 8 0 %和 2 8%。 (2 )CMCS队列男女两性高胆固醇血症、高血压、男性低高密度脂蛋白胆固醇 (HDL C)血症和女性的吸烟率低于弗莱明翰队列 ,男性吸烟率高于弗莱明翰队列。 (3)与弗莱明翰队列中各危险因素的相对危险度 (RR)相比 ,CMCS队列中男性年龄的RR较高且差异有显著性 ;CMCS队列男性总胆固醇 (TC)为 5 2 0～ 6 2 3mmol L时、HDL C低于 0 91mmol L时以及女性吸烟时的RR较低 ,差异有显著性。其他多数危险因素的RR在两队列中的差异未达统计学显著性。 (4)CMCS模型和弗莱明翰模型都有较好的判别病例和非病例的能力。CMCS模型和弗莱明翰模型男性ROC曲线下面积分别为 0 736和 0 70 5 ,女性分别为     

老年创伤患者临床特征和死亡危险因素分析

目的 总结老年重症创伤的临床特征,分析死亡危险因素。方法 回顾性地分析2010年1月至2014年10月张家港市第一人民医院重症监护室（ICU）收治的130例老年创伤患者和120例青中年创伤患者的致伤原因、伤情、救治及转归。结果 老年创伤组急性生理与慢性健康评分（APACHE Ⅱ）为（19.71±12.48）分,合并基础疾病率39.2%,住ICU的时间为（6.17±5.97）d,机械通气率56.2%,多器官功能不全综合征（MODS）发生率36.9%,肺部感染发生率22.3%,病死率34.6%,均高于青中年创伤组（P＜0.05）。结论 老年创伤患者病死率高于中青年患者,APACHE Ⅱ评分、较多的基础疾病和MODS的发生是其独立危险因素。     

The Systolic Blood Pressure Difference Between Arms and Cardiovascular Disease in the Framingham Heart Study

Background

An increased interarm systolic blood pressure difference is an easily determined physical examination finding. The relationship between interarm systolic blood pressure difference and risk of future cardiovascular disease is uncertain. We described the prevalence and risk factor correlates of interarm systolic blood pressure difference in the Framingham Heart Study (FHS) original and offspring cohorts and examined the association between interarm systolic blood pressure difference and incident cardiovascular disease and all-cause mortality.

Methods

An increased interarm systolic blood pressure difference was defined as ≥10 mm Hg using the average of initial and repeat blood pressure measurements obtained in both arms. Participants were followed through 2010 for incident cardiovascular disease events. Multivariable Cox proportional hazards regression analyses were performed to investigate the effect of interarm systolic blood pressure difference on incident cardiovascular disease.

Results

We examined 3390 (56.3% female) participants aged 40 years and older, free of cardiovascular disease at baseline, mean age of 61.1 years, who attended a FHS examination between 1991 and 1994 (original cohort) and from 1995 to 1998 (offspring cohort). The mean absolute interarm systolic blood pressure difference was 4.6 mm Hg (range 0-78). Increased interarm systolic blood pressure difference was present in 317 (9.4%) participants. The median follow-up time was 13.3 years, during which time 598 participants (17.6%) experienced a first cardiovascular event, including 83 (26.2%) participants with interarm systolic blood pressure difference ≥10 mm Hg. Compared with those with normal interarm systolic blood pressure difference, participants with an elevated interarm systolic blood pressure difference were older (63.0 years vs 60.9 years), had a greater prevalence of diabetes mellitus (13.3% vs 7.5%,), higher systolic blood pressure (136.3 mm Hg vs 129.3 mm Hg), and a higher total cholesterol level (212.1 mg/dL vs 206.5 mg/dL). Interarm systolic blood pressure difference was associated with a significantly increased hazard of incident cardiovascular events in the multivariable adjusted model (hazard ratio 1.38; 95% CI, 1.09-1.75). For each 1-SD-unit increase in absolute interarm systolic blood pressure difference, the hazard ratio for incident cardiovascular events was 1.07 (95% CI, 1.00-1.14) in the fully adjusted model. There was no such association with mortality (hazard ratio 1.02; 95% CI 0.76-1.38).

Conclusions

In this community-based cohort, an interarm systolic blood pressure difference is common and associated with a significant increased risk for future cardiovascular events, even when the absolute difference in arm systolic blood pressure is modest. These findings support research to expand clinical use of this simple measurement.     

Lifetime risk for developing dyslipidemia: the Framingham Offspring Study

Background

High serum low-density lipoprotein (LDL) cholesterol and low high-density lipoprotein (HDL) cholesterol are major vascular risk factors. National surveys indicate that 40% of individuals in the United States have borderline-high LDL cholesterol, and 13-34% have low HDL. The lifetime risk of developing dyslipidemia is unknown, however.

Methods

We estimated the 10- to 30-year long-term risks of developing “borderline-high” LDL cholesterol (≥130 mg/dL [3.4 mmol/L]), “high” LDL cholesterol (≥160 mg/dL [4.1 mmol/L]) and “low” HDL cholesterol (<40 mg/dL [1.0 mmol/L]) in 4701 Framingham Offspring Study participants (53% women) who attended at least 2 examinations between 1971 and 2000. We performed sex-specific analyses (for age groups 30-34, 40-44, 50-54 years), and estimated risks conditional on surviving without the lipid abnormality up to the baseline age. We also estimated risks accounting for baseline prevalence of dyslipidemia (elevated LDL, low HDL).

Results

Over a 30-year period, approximately 6 of 10 participants developed borderline-high LDL, 4 of 10 people developed high LDL, and 2 (women) to 4 (men) of 10 individuals developed low HDL levels; estimates were generally similar for different age groups. Adjustment for baseline prevalence of dyslipidemia increased these estimates: 30-year risks exceeded 80% for borderline-high LDL, 50% for high LDL, and 25% (women) to 65% (men) for low HDL; 20-50% had or developed a low HDL along with a high LDL level. The 30-year estimates approximate the lifetime risk in 50-year-olds.

Conclusions

The long term risks of developing dyslipidemia are substantial in both sexes, and considerably exceed prevalence estimates from cross-sectional surveys.     

老年急性心肌梗死患者死亡及危险因素的回顾性分析

目的：探讨不同年龄段老年急性心肌梗死（AMI）患者的死亡情况及危险因素。方法回顾性地分析2006年12月至2012年1月入院的883例60～89岁的AMI患者（按年龄分为两组,60～74岁为老年组共473例,75～89岁为高龄组共410例）的一般情况、既往病史及家族史、临床检查及诊断、并发症、治疗及生存情况。结果老年组死亡率明显低于高龄组（5.9%vs 14.6%,P＝0.000）,经皮冠状动脉介入（PCI）治疗率明显高于高龄组（92.6%vs 69.8%,P＝0.000）。两组患者死亡均与尿素氮、血糖、白细胞、脑钠肽（BNP）水平高,并发窦性停搏、心室颤动、心房颤动、心源性休克、Killip 3-4级,使用主动脉内球囊反搏（IABP）,未手术呈正相关;与药物（包括血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂、β受体阻滞剂、他汀类药物）使用率呈负相关。尿素水平高、并发窦性停搏与心源性休克、未手术为两组患者死亡的独立危险因素。结论积极PCI治疗可改善老年AMI患者预后,需重视其尿素氮水平及窦性停搏、心源性休克等并发症。     

Plasma renin and risk of cardiovascular disease and mortality: the Framingham Heart Study.

AIMS: Previous studies relating plasma renin to cardiovascular disease (CVD) and mortality yielded conflicting results. We related plasma renin to incidence of CVD and mortality in 3408 individuals (mean age 59; 53% women) and in a hypertensive subset (n = 1413). METHODS AND RESULTS: On follow-up (mean 7.1 years), 176 participants (122 hypertensives) developed CVD and 215 individuals (127 hypertensives) died. Overall, log-renin was associated with mortality [multivariable-adjusted hazards ratio (HR) per SD increment: in whole sample, 1.14, 95% confidence interval (CI) 1.00-1.30, P = 0.046; hypertensives, 1.16, 95% CI 1.00-1.35, P = 0.046], but relations varied over time (P < 0.02). Log-renin was associated with mortality at 2.5 years of follow-up (HR per SD increment: whole sample at 2.5 years, 1.23, 95% CI 1.04-1.45; hypertensives at 2 years, 1.28, 95% CI 1.06-1.54), but not during longer follow-up (HR per SD increment at 5 years: whole sample, 1.02, 95% CI 0.80-1.29; hypertensives, 0.98, 95% CI 0.74-1.30). The time-dependent relation of renin and mortality risk was maintained upon excluding participants with prevalent CVD. Renin was not associated with CVD incidence (HR per SD increment log-renin: whole sample, 0.99, 95% CI 0.85-1.14; hypertensives, 0.96, 95% CI 0.82-1.12). CONCLUSION: Higher plasma renin was associated with greater short-term mortality but not with CVD incidence in the community.     

Risk Factors of Mortality from Foreign Bodies in the Respiratory Tract: The Japan Collaborative Cohort Study

Objective This study assessed the risk factors of mortality from foreign bodies in the respiratory tract using the Japan Collaborative Cohort Study for the Evaluation of Cancer Risk data. Methods Data of 110,585 participants 40-79 years old living in 45 areas in Japan were collected between 1988 and 2009. Mortality from foreign bodies in the respiratory tract was assessed in a multivariable-adjusted analysis using a Cox proportional hazard regression model. Results Among all participants, 202 deaths occurred from foreign bodies in the respiratory tract. In the multivariable-adjusted model, older age [50-59 (hazard ratio, 4.93; 95% confidence interval, 1.91-12.74), 60-69 (hazard ratio, 14.96, 6.01-37.25) and 70-79 (hazard ratio, 53.81; 95% confidence interval, 21.44-135.02) years old compared to 40-49 years old], male sex (hazard ratio, 2.34; 95% confidence interval, 1.54-3.54), a history of apoplexy (hazard ratio, 7.04; 95% confidence interval, 4.24-11.67) and the absence of a spouse (hazard ratio, 1.56; 95% confidence interval, 1.05-2.32) were associated with an increased risk of mortality from foreign bodies in the respiratory tract. Conclusions Older age, male sex, medical history of apoplexy and the absence of a spouse were potential risk factors of mortality from foreign bodies in the respiratory tract. Especially in elderly men, social connections, such as cohabitation or relationships, may be important for ensuring the early detection of asphyxia and preventing death due to foreign bodies in the respiratory tract.     

Perinatal and familial risk factors for irritable bowel syndrome in a Swedish national cohort

Objective: Studies of the importance of perinatal factors for the development of irritable bowel syndrome (IBS) are sparse. We conducted a large national cohort study to examine perinatal and familial risk factors for IBS.

Material and methods: A national cohort of 1,963,685 persons who were born in Sweden in 1973–1992 (identified from the Swedish Birth Registry) were followed up for adult (18 years and older) IBS incidence in the Swedish Patient Register through 2010 (maximum age 38 years). There were 24,633 IBS cases in 46,784,296 person-years of follow-up.

Results: After adjusting for potential confounders, significant risk factors for IBS included caesarean (HR?=?1.10, 95% confidence interval [CI] 1.05–1.11, p?p?=?.02), being second in birth order (HR?=?1.04, 95%CI 1.01–1.08, p?=?.01), foetal growth ≥1 SD (HR?=?1.06, 95%CI 1.00–1.11, p?=?.05), young maternal age (<20 years) (HR=?1.09, 95%CI 1.02–1.17, p?=?.02), maternal marital status (divorced/widowed) (HR?=?1.12, 95%CI 1.08–1.17, p?p?=?.01), maternal education of 12–14 years (HR?=?1.06, 95%CI 1.01–1.11, p?=?.03), parental history of IBS (HR?=?1.54, 95%CI 1.42–1.66, p?p?p?=?.02). Protective factors were male sex (HR?=?0.36, 95%CI 0.35–0.37, p?p?=?.03).

Conclusions: In this large cohort study, several perinatal and familial factors were associated with an increased risk of IBS independently, suggesting that perinatal and familial factors may play an important long-term role in the aetiology of IBS.     

Relationship Between Heart Rate Variability and Cardiovascular Risk Factors in Middle-Aged Males

Background: Abnormal autonomic control of heart rate is associated with an inreased risk of cardiovascular morbidity and mortality. There are few population-based reports on the interindividual variation and determinants of cardiac control in healthy middle-aged males. Methods: Autonomic modulation of heart rate was studied in 172 randomly selected middle-aged males (mean age 50 ± 6 years) by measuring the heart rate variability (HRV), which was related to life style data, personality type, blood pressure, lipid analyses, results of the 2-hour glucose tolerance test and left ventricular function. Results: Large interindividual variation was observed in the standard deviation of RR intervals (mean 59 ± 20 ms; coefficient of variation (CV) 34%) compared to variation of the average heart rate (mean 76 ± 11 beats/min, CV 14%). When analyzed as normalized units, marked interindividual variation was observed in the low (CV 16%) and high frequency component (CV 37%). The total power of HRV had significant indirect univariate correlations with age, blood pressure, body mass index, 2-hour blood glucose level, fasting and 2-hour serum insulin levels, triglyceride level, and a direct correlation with left ventricular fractional shortening. In a multiple regression analysis, the total power of HRV was best predicted by age (β=?0.27, P = 0.0002), followed by the fractional shortening (β= 0.25, P = 0.0004), systolic blood pressure (/3 =?0.2 1, P = 0.005) and 2-hour insulin level (β=?0. 9, P = 0.01). Conclusions: Overall HRV has a wide interindividual variation and is related to several cardiovascular risk factors, perhaps contributing to the observed association between low HRV and cardiovascular mortality. Normalized units of HRV reflecting sympathovagal balance are unrelated to age, life style, or cardiovascular risk factors.     

Homocysteine as a risk factor for CVD mortality in men with other CVD risk factors: the Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study

OBJECTIVE: Based on case-control and prospective studies elevated blood total homocysteine (tHcy) has been suggested to be an independent risk factor for cardiovascular diseases (CVD). The purpose of the study was to explore the joint effect of increased serum tHcy concentration and other risk factors on the risk of CVD mortality in middle-aged men without a history of heart disease or stroke. DESIGN: A prospective, population-based Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study. SETTING: Eastern Finland. Subjects. A total of 802 men aged 46-64 years, examined in 1991-93. MAIN OUTCOME MEASURES: CVD mortality event. RESULTS: The mean serum tHcy concentration was 10.8 micromol L(-1) (SD 3.3). During the average follow-up time of 10.8 years 50 men experienced a CVD death. The hazard rate ratio for CVD mortality was 1.80 (95% confidence interval: 1.02-3.19) in men in the highest serum tHcy third versus lower thirds after adjustment for cardiovascular risk factors. Furthermore, elevated serum tHcy concentration appeared to increase the risk of CVD death in men who smoke or who have high circulating concentrations of serum total or LDL cholesterol, apo-B apolipoprotein or plasma fibrinogen. CONCLUSION: We conclude that homocysteine may increase the risk of CVD mortality in middle-aged men from Eastern Finland, and it may especially increase the risk when present with other risk factors for CVD.