Conditional logistic regression analysis of coronary heart disease

A case-control study on 215 pairs was carried out in Jinan. Conditional Logistic regression analysis showed that the following five factors were associated with coronary heart disease, i.e., hypertension, hypercholesterolemia and heavy smoking, serum copper and HDL-C/TC. The former three were risk factors, and the latter two were protective factors. There is remarkable dose-response relation between heavy smoking and coronary heart disease. The data analysis show that these five factors are contributory to coronary heart disease with synergism.     

Erectile dysfunction: a significant health need in patients with coronary heart disease

BACKGROUND AND AIMS: Erectile dysfunction (ED) is a common condition, which negatively affects quality of life, and shares similar risk factors with Coronary Heart Disease (CHD). Studies from the pre - sildenafil era confirm a higher risk of ED in patients with cardiovascular disease. The high profile and success of sildenafil therapy has made it easier for some men to discuss erectile difficulties with healthcare professionals. Our aim therefore was to estimate the prevalence of ED in our cardiac rehabilitation patients . METHODS AND RESULTS: We surveyed 150 random male cardiac rehabilitation patients using the International Index of Erectile Function (IIEF) questionnaire. 61% of all respondents had erectile difficulties, rising to 75% in the over 55 age group. 48% of respondents indicated their wish to discuss erectile problems with the healthcare team. CONCLUSION: ED and CHD commonly co-exist. A large proportion of our respondents wished further discussion of erectile insufficiency. We recommend that cardiac rehabilitation programmes should adopt a proactive approach to detection and treatment of ED.     

冠心病危险因素的Logistic回归分析

目的 分析冠心病（CHD）与其常见危险因素之间的关系、心肌梗塞（MI）和心绞痛（AP）间的关系及早发冠心病的特点，为CHD的预防提供理论依据。方法 通过病例一对照研究设计，对病例组235例和对照组进行Logistic回归分析，探讨CHD的危险因素。结果 结论 高血压病史、CHD家族史、糖尿病、吸烟、血脂异常和超重是冠心病的主要危险因素；吸烟、被动吸烟史、冠心病家族史可能是冠心病患者发生心绞痛事件的危险因素；吸烟、冠心病家族史可能是导致早期发现冠心病的重要原因。     

Characteristics of individuals with multiple behavioral risk factors for coronary heart disease: the Netherlands.

To test the hypothesis that risk factors are interrelated, the simultaneous occurrence of smoking, inadequate nutrition, obesity, and physical inactivity was studied in a random sample (n = 1,951) of the Dutch adult population. Although the results did not suggest systematic clustering, the assumption of independence of these risk factors could not be maintained. Sociodemographic and health-related characteristics of the group with three or four risk factors were assessed (n = 246). Comparison with a prudent life-style group (zero risk factors, n = 387) by means by discriminant analysis indicated that the target group included proportionally more men (odds ratio: OR = 3.3), of all ages, with low education and occupation (OR = 3.5 and 1.7). The two groups did not differ in awareness of cardiovascular risk factors, preventive orientation regarding cardiovascular risk, or disease in general, and the effectiveness of health education in modifying life-style. The target group exhibited a distorted perception of the healthfulness of its own life-style and unfavorable attitudes toward modifying existing smoking, eating habits, and physical activity.     

二分类 Logistic 回归在冠心病危险因素研究中的应用

目的：应用二分类Logistic回归在可能引发冠心病影响因素中筛选危险因素,建立冠心病危险因素“最优”回归方程。方法采取系统抽样方法,对某几所医院心血管内科初诊为冠心病并进行冠脉造影病例,抽取400例30～65岁患者病例作为样本。通过二分类Logistic回归方法分析冠心病与危险因素的相关关系。结果以是否冠心病为因变量,各因素为自变量,筛选影响因素。经相关分析、共线性诊断,筛选出冠心病危险因素为年龄、合并疾病、吸烟、收缩压、血糖、尿酸、低密度脂蛋白、脂蛋白（ a）。结论用二分类Logistic回归找出危险因素,可以有效分析各因素的相对重要性。     

How equitable are GP practice prescribing rates for statins?: an ecological study in four primary care trusts in North West England

Background  

There is a growing body of literature highlighting inequities in GP practice prescribing rates for a number of drug therapies. The small amount of research on statin prescribing has either focussed on variations rather than equity per se, been based on populations other than GP practices or has used cost-based prescribing rates.     

Predictive model of coronary heart disease in Egypt (a disease with multiple risk factors)

As a multifactorial disease and with the need of primordial prevention coronary heart disease (CHT), a risk scoring system for the prediction of CHD was devised at Community Medicine Department Ain Shams University, Cairo, EGYPT. In this matched case-control study of 119 cases and 121 age and sex matched controls, current cigarette smoking, lack of siesta, hypertension, diabetes mellitus, low occupational physical activity, hypercholesterolemia, marital status, urban residence, level of education, work index, coffee consumption, positive family history, BMI, elevated W/H ratio, low HDL and elevated TC/HDL were studied for association with CHD. The additive risk scoring system based on the results of conditional multiple logistic regression identified the first six factors with statistical weights of 1, 5, 10, 6, 6, 11, respectively. On back validation receiver operating characteristic (ROC) curve, a total score of 17 was found to be the cut off point above which there was increased risk of CHD. The overall predictive accuracy of this system--equivalent to the area under the ROC curve--was 0.873. Future studies need to assess the risk scoring system in population based studies.     

Translating policy into practice: a case study in the secondary prevention of coronary heart disease

Background This paper focuses on the relationships between health ‘policy’ as it is embodied in official documentation, and health ‘practice’ as reported and reflected on in the talk of policy‐makers, health professionals and patients. The specific context for the study involves a comparison of policies relating to the secondary prevention of coronary heart disease (CHD) in the two jurisdictions of Ireland – involving as they do a predominantly state funded (National Health Service) system in the north and a mixed health‐care economy in the south. The key question is to determine how the detail of health policy as contained in policy documents connects to and gets translated into practice and action. Methods The data sources for the study include relevant health‐care policy documents (N = 5) and progress reports (N = 6) in the two Irish jurisdictions, and semi‐structured interviews with a range of policy‐makers (N = 28), practice nurses (14), general practitioners (12) and patients (13) to explore their awareness of the documents’ contents and how they saw the impact of ‘policy’ on primary care practice. Results The findings suggest that although strategic policy documents can be useful for highlighting and channelling attention to health issues that require concerted action, they have little impact on what either professionals or lay people do. Conclusion To influence the latter and to encourage a systematic approach to the delivery of health care it seems likely that contractual arrangements – specifying tasks to be undertaken and methods for monitoring and reporting on activity – are required.     

Relative cost effectiveness of the SPHERE intervention in selected patient subgroups with existing coronary heart disease

Heterogeneity exists within the patient population with coronary heart disease and the cost effectiveness of treatment may vary across subgroups within the overall population. This study compares the cost effectiveness of a secondary prevention intervention for a combined patient population relative to three selected subgroups: patients aged over 70?years; patients with a diagnosis other than angina only (that is, patients with a history of myocardial infarction, coronary artery bypass graft and/or percutaneous transluminal coronary angioplasty); and patients with diabetes. The results for the general population have been published elsewhere, but ongoing budget constraints require consideration of the appropriateness of targeting resources to patient subgroups. We adopt a probabilistic model to combine within trial and beyond trial impacts of treatment to estimate the lifetime health care costs and quality-adjusted life years of two primary care-based secondary prevention strategies: SPHERE Intervention—tailored practice and patient care plans and Control—standardised usual care. In all cases, the intervention was associated with mean cost savings and mean QALYs gains, when compared to the control, though statistical significance was never achieved. However, the probability of the intervention being cost effective was higher than 85% in all analyses across a range of potential cost-effectiveness threshold values. There is no compelling statistical evidence to support the targeting of specific subgroups across the general population. However, if affordability constraints are binding, the results do allow a tentative ranking of priorities based on the probabilistic subgroup analysis.     

Variations in practice admission rates: the policy relevance of regression standardisation

OBJECTIVES: To explore variations in general practice admission rates, comparing standardisation by regression with direct standardisation of the data to identify explained and unexplained variation. METHODS: Data from hospital episode statistics and the attribution dataset on 8048 cataract admissions from 109 practices in an English health district (North Yorkshire) between 1995 and 1998. Multiple regression was used to estimate the effect of practice characteristics, socio-economic factors, waiting times and distance on practice admission rates. Rankings of practices by the residuals from the regression were compared with rankings by directly standardised admission rates. RESULTS: The regression model yielded intuitively plausible results and explained 35% of the cross-practice variation in directly standardised admission rates. Standardisation by regression, compared with direct standardisation, made as least as much difference to the ranking of practices as direct standardisation compared with crude admission rates. Regression standardisation suggested that 10 practices not identified as 'unusual' by comparison of their rates to the district mean were in fact 'unusual', and that six practices identified as unusual by comparison with the district mean were not unusual once allowing for the explanatory factors used in the regression model. CONCLUSIONS: Given the increasing importance of systematic performance assessment to support quality improvement, care must be taken when interpreting variations in health care activity even after conventional standardisation of the data. If significant variations are detected, regression analysis can assist in explaining some of it, which is the starting point in informing discussions about whether variations are justified or unjustified.     

冠心病合并心力衰竭患者再住院影响因素的多水平模型

目的  构建多水平Cox回归模型,分析冠心病合并心力衰竭患者再住院的影响因素。 方法  2014年1月-2017年12月在山西省两所三甲医院连续入选符合标准的1 433例冠心病合并心衰的住院患者。记录患者住院的病历资料（包括基线资料、检查及治疗情况等）并对其进行随访,中位随访期为23个月。应用单因素Cox回归分析及多因素Cox回归分析对自变量进行筛选;采用两水平Cox回归模型进行影响因素的分析。 结果  研究对象中的436（30.4%）例患者发生了再住院,两水平Cox回归分析结果显示高龄（HR=1.010,95%CI：1.001~1.019,P=0.032）、男性（HR=1.234,95%CI：1.009~1.509,P=0.040）、体力劳动（HR=1.458,95%CI：1.036~2.050,P=0.030）、市医保（HR=1.513,95%CI：1.120~2.043,P=0.007）、QRS波间期延长（HR=1.004,95%CI：1.001~1.008,P=0.018）是冠心病合并心力衰竭患者再住院的独立危险因素;高尿比重（HR=0.000,95%CI：0.000~0.059,P=0.021）为冠心病合并心衰患者再住院的保护因素。 结论  年龄、性别、职业、市医保、QRS间期及尿比重是冠心病合并心衰患者再住院的影响因素;加强临床护理监测和完善社会保障制度可以减少患者再住院的发生。     

Occurrence in children of multiple risk factors for coronary artery disease: the Bogalusa heart study.

The aggregation at high levels of risk factor variables for coronary artery disease (CAD) was studied in 4064 children of a biracial population in Bogalusa, Louisiana. Above the age-, race-, and sex-specific 75th percentiles for serum cholesterol, blood pressure, and a weight-height index were 144 (3.33%) schoolchildren. This was greater than expected (P <0.001) under a null hypothesis of no association. The relationship was stronger in white males (3.8%) and black females (4.0%) than in white females (2.8%) and black males (2.7%). This aggregation tended to increase with age. For preschool children we found no more aggregation than expected. Data from these and future observations may enable us to identify a cohort of children who persistently exhibit multiple risk factor variables at high levels. This identification would be essential should prevention efforts for CAD be initiated.     

冠心病合并2型糖尿病患者冠状动脉造影分析

目的 探讨冠心病合并2型糖尿病患者的冠状动脉(冠脉)造影特点.方法 716例冠心病患者,均行冠脉造影检查.其中冠心病合并2型糖尿病患者340例作为观察组,冠心病不合并2型糖尿病患者376例作为对照组.对两组患者的冠脉造影资料进行分析.结果 观察组多支病变高于对照组(56.2%比34.6%,P＜0.05),C型病变高于对照组(54.1%比24.5%,P＜0.05).结论 冠心病合并2型糖尿病患者冠脉病变广泛且复杂.     

冠心病合并2型糖尿病患者冠状动脉造影分析

目的探讨冠心病合并2型糖尿病患者的冠状动脉（冠脉）造影特点。方法716例冠心病患者，均行冠脉造影检查。其中冠心病合并2型糖尿病患者340例作为观察组，冠心病不合并2型糖尿病患者376例作为对照组。对两组患者的冠脉造影资料进行分析。结果观察组多支病变高于对照组（56．2％比34．6％，P〈0．05），C型病变高于对照组（54．1％比24．5％，P〈0．05）。结论冠心病合并2型糖尿病患者冠脉病变广泛且复杂。     

Rationale for multiple risk intervention: the need to move from theory to practice

Incidence of cardiovascular (CV) and metabolic disease is increasing, in parallel with associated risk factors. These factors, such as low-density lipoprotein (LDL)-cholesterol, elevated blood pressure, obesity, and insulin resistance have a continuous, progressive impact on total CV risk, with higher levels and numbers of factors translating into greater risk. Evaluation of all known modifiable risk factors, to provide a detailed total CV disease (CVD) and metabolic risk-status profile is therefore necessary to ensure appropriate treatment of each factor within the context of a multifactorial, global approach to prevention of CVD and metabolic disease. Effective and well-tolerated pharmacotherapies are available for the treatment of risk-factors. Realization of the potential health and economic benefits of effective risk factor management requires improved risk factor screening, early and aggressive treatment, improved public health support (ie, education and guidelines), and appropriate therapeutic interventions based on current guidelines and accurate risk assessment. Patient compliance and persistence to available therapies is also necessary for successful modulation of CVD risk.     

The role of non-need factors in individual GP utilisation analysis and their implications for the pursuance of equity: a cross-country comparison

A substantial amount of health care resources is allocated within the UK using formulae that relate funding to measures of population need. The aim of this paper is to demonstrate the importance of non-need factors in determining utilisation of services at an individual level and explore the implications inclusion of such factors has in the consideration of equity. In the paper we develop a utility model that accords a role to non-health factors in the determination of service use. A series of functions incorporating non-health factors as explanatory variables in GP utilisation functions are estimated using data from the British Household Panel Survey. The functions are decomposed to ascertain the role of service structure and examine the role of income across the four countries of the UK in explaining utilisation. The implications of our findings for the pursuance of equity in the NHS when individual choice has an explicit role are discussed.