Coronary heart disease: prevalence and dietary sugars in Scotland.

STUDY OBJECTIVE--The aim was to investigate the effects of dietary intakes of different types of sugars (extrinsic, intrinsic, and lactose) and the dietary fat to sugar ratio on prevalent coronary heart disease (CHD). DESIGN--This was a baseline cross sectional survey of CHD risk factors. SETTING--Twenty two Scottish health districts were surveyed between 1984 and 1986. PARTICIPANTS--A total of 10,359 men and women aged 40-59 years were screened as part of the Scottish Heart Health Study, and a further 1267 men and women aged 25-39 and 60-64 years were screened as part of the Scottish MONICA (monitoring trends and determinants in cardiovascular disease) Study. The response rates were 74% and 64% respectively. METHODS--Subjects completed a questionnaire which included sociodemographic, health, and food frequency information. Medical history, response to the Rose chest pain questionnaire, and results of a 12 lead ECG recording were used to categorize subjects into CHD diagnosed, previously CHD undiagnosed, or no CHD groups. The chi 2 statistic was used to determine whether the CHD groups differed in their sugar consumption, and multiple logistic regression analysis, with adjustment for other potential coronary risk factors, was used to calculate odds ratios for prevalent CHD by intake fifths of dietary sugars. MAIN RESULTS--Men, but not women, differed in their sugar consumption by CHD group. The odds ratios showed a tendency for a U shaped relationship for extrinsic sugar intake with CHD prevalence, but no significant effect of the fat to sugar ratio (possible marker of obesity) on CHD was seen. CONCLUSIONS--The results suggest that neither extrinsic sugar, intrinsic sugar, nor the fat to sugar ratio are significant independent predictors of prevalent CHD in the Scottish population, when the other major risk factors such as cigarette smoking, blood cholesterol concentration, and antioxidant vitamins intake are accounted for. These new data for different sugar types agree with the consensus view that total sugar intake is not a major marker of coronary heart disease.     

Alcohol consumption, diet, coronary risk factors, and prevalent coronary heart disease in men and women in the Scottish heart health study.

STUDY OBJECTIVE--To measure the relationship between reported alcohol consumption and prevalent diagnosed and undiagnosed coronary heart disease (CHD) in men and women to see how much could be explained by covariation with diet, lifestyle, and biomedical factors. DESIGN AND SETTING--This was a cross sectional, random population survey covering 22 districts of Scotland and using general practitioner patient lists as the sampling frame. Odds ratios for prevalent CHD at different levels of alcohol consumption taken from a seven day recall were analysed. These ratios were then adjusted for lifestyle and biomedical factors. PARTICIPANTS--Male and female responders aged 40-59 years who completed the survey questionnaire and attended the survey clinic. MAIN RESULTS--The participation rate of those invited was 74%. Of the 10,359 responders, 658 were excluded because of missing alcohol data or ambiguous cardiovascular status. The questionnaire was used to designate 7058 drinkers and 2643 non-drinkers, who were then classified as having diagnosed or undiagnosed CHD, or who were controls. The prevalence of diagnosed CHD decreased with increasing alcohol consumption while undiagnosed CHD had a "U" shaped relationship. Patterns were similar in men and women if allowance was made for the lower alcohol consumption in women. Adjustment for several diet and lifestyle factors and for additional biomedical factors reduced the apparent protective effect of alcohol, leaving a modest but statistically insignificant (p > 0.05) reduction in CHD prevalence among light to moderate consumers compared with those who drank no alcohol. Wine drinkers seemed to be at lower risk than beer drinkers in both sexes. CONCLUSIONS--These results tend to confirm that intermediate alcohol consumption is a component and contributor to a low coronary risk lifestyle. Its effects are largely explained by adjusting for both confounding lifestyle associations and for biomedical effects but the remaining effect, and the lower risk with wine drinking compared with beer, are intriguing. Advice on alcohol habits should not be determined solely by the moderate apparent benefit to risk of CHD, however, as other disease risks cannot be ignored.     

Coffee and tea consumption and the prevalence of coronary heart disease in men and women: results from the Scottish Heart Health Study.

STUDY OBJECTIVES--The aim was to determine if there was a relationship between coffee or tea consumption and the prevalence of coronary heart disease in Scotland. DESIGN--The relationship between self reported coffee and tea consumption and the prevalence of coronary heart disease (history, symptoms, or electrocardiographic evidence) was investigated using multiple logistic regression analysis in the Scottish Heart Health Study (SHHS), a cross sectional study. SETTING--Twenty two Scottish districts were surveyed for the SHHS between 1984 and 1986. SUBJECTS--A total of 10,359 men and women aged 40-59 years were studied. MEASUREMENTS AND MAIN RESULTS--Of the 9740 subjects who were assigned a category, 21.8% (2122) were classified as having indications of coronary heart disease. Men and women were combined in the odds ratio analysis because they showed almost identical patterns in the prevalence of coronary heart disease across the coffee and tea quarters (grouped according to consumption). Those who did not drink coffee had a significantly higher (p < 0.05) prevalence of coronary heart disease than the three groups for coffee drinkers. Adjustments for risk factors including cigarette smoking, total blood cholesterol, and diastolic blood pressure did not remove the significance of the odds ratios. There was a positive dose-response effect between tea consumption and coronary heart disease which was removed after adjustment for various risk factors. CONCLUSIONS--These findings do not support a positive relationship between coffee or tea consumption and coronary heart disease in this British study where most coffee consumed is instant coffee.     

The Scottish Heart Health Study. Dietary intake by food frequency questionnaire and odds ratios for coronary heart disease risk. I. The macronutrients.

Identification of the risk of coronary heart disease (CHD) from nutrients in the diet is of importance to both primary and secondary disease prevention. This paper reports the mean intakes and odds ratios for the macronutrients in groups of CHD-diagnosed, -undiagnosed and CHD-free men and women, aged 40-59 years, who participated in the Scottish Heart Health Study (n = 10,359). Diet was assessed by food frequency questionnaire and odds ratios were determined relative to the lowest quintile and adjusted for the classical CHD risk factors (+/- social class). Six per cent of the study population were CHD-diagnosed and 14.5% were identified as possible cases of undiagnosed CHD. The results suggest that change in diet as a result of diagnosis does occur, and is more pronounced in men. The effect is to give odds ratios, for diagnosed CHD, opposite to those which may be expected on the basis of current knowledge of nutrition and CHD risk. According to the intake data from the undiagnosed group, a relatively low energy intake, a high percentage of energy from protein and a moderate percentage of energy from alcohol diet are favourable factors with respect to CHD risk for men. For women, only alcohol significantly altered risk of undiagnosed CHD, and surprisingly, no measure of dietary fat showed a modifying effect on risk of undiagnosed CHD for men or for women. The implications, and influence of measurement error and variance on these results are discussed.     

Dietary antioxidant vitamins and fiber in the etiology of cardiovascular disease and all-causes mortality: results from the Scottish Heart Health Study

In this paper, data obtained between 1984 and 1993 from 11,629 men and women as part of the Scottish Heart Health Study (Scotland, United Kingdom) were used to investigate the relation between antioxidant vitamin and fiber intakes and both incident coronary heart disease (CHD) (649 events) and all-causes mortality (591 deaths). All age-adjusted mean intakes tended to be higher in the group that experienced no event. For men, increased fiber intake was associated with decreased risk of CHD even after adjustment for a host of other major coronary risk factors; hazard ratios relative to the lowest quarter were 0.68, 0.70, and 0.64 by increasing quarter. This relation was also observed for mortality (hazard ratios of 0.62, 0.66, and 0.62). Evidence was found that higher intakes of the antioxidants were also beneficial, although the associations were weaker. For women, fiber was the only obviously influential dietary factor, with hazard ratios of 0.94, 0.60, and 0.56 for CHD and 1.25, 0.82, and 0.65 for mortality. These results suggest that the current public health drive to increase the consumption of foods rich in antioxidant vitamins and (particularly) fiber will impact on both CHD risk and the general health of the population.     

Contribution of contemporaneous risk factors to social inequality in coronary heart disease and all causes mortality

BACKGROUND: The relationship between low social status and premature mortality is well established, although the explanation for this link is unclear. This study explores the contribution to the social inequalities in coronary heart disease (CHD) and death of smoking status, cotinine, alcohol status, type A personality score, leisure activity, diabetes, systolic and diastolic blood pressure, body mass index, total and HDL cholesterol, triglycerides, fibrinogen, and vitamin C consumption. METHODS: A random sample of 11,629 Scottish men and women, ages 40-59 years, was recruited in 1984-1987 and followed up for an average of 7.7 years for death and major coronary events. Social status was measured by housing tenure--renters being more socially deprived. Hazard ratios were computed from Cox models. RESULTS: Adjusted for age, renters have 1.48 times the risk of CHD compared to owner-occupants (95% CI: 1.21, 1.80) in men and 2.64 (1.89, 3.68) in women, and for all-cause mortality 1.55 (1.26, 1.90) and 2.12 (1.58, 2.84). The 14 risk factors explained 73% (men) and 77% (women) of the social differences in CHD. Equivalent figures for deaths were 51 and 64%. CONCLUSIONS: Fourteen contemporaneous risk factors, smoking being the most important, explain most of the social differential in CHD and death.     

Omega-3 fatty acid supply from milk associates with lower type 2 diabetes in men and coronary heart disease in women

BACKGROUND: Omega-3 fatty acids may prevent type 2 diabetes and coronary heart disease (CHD). We investigated these fatty acids in Nordic cow's milk and whether their supply from milk associates with type 2 diabetes prevalence and CHD mortality in the Nordic countries. METHODS: Samples (N = 84) of consumers' milk were collected in five Nordic countries four times during 1 year. Fatty acids were analyzed using gas chromatography. Fatty acids supply from milk fat was calculated using national food balance sheets. RESULTS: The omega-3 fatty acids content was higher and omega-6 fatty acid content was lower in Icelandic milk when compared with milk from other Nordic countries. Type 2 diabetes prevalence in men correlated inversely with the supply of omega-3 fatty acids and eicosapentaenic acid, but positively with omega-6/omega-3 ratio in milk. CHD mortality in women correlated inversely with the supply of eicosapentaenic acid but positively with the omega-6/omega-3 ratio. CONCLUSIONS: Milk fatty acids content can depend upon the origin of the milk. The higher supply of omega-3 fatty acids from milk might explain the lower type 2 diabetes prevalence and CHD mortality in Iceland compared to the other Nordic countries.     

Social status and coronary heart disease: results from the Scottish Heart Health Study.

Social status has frequently been found to be associated with the prevalence of coronary heart disease. Currently, in developed countries, it seems that the least advantaged social groups are at the greatest risk. This article addresses this issue in the Scottish population, using a cross-sectional sample of 10,359 men and women. Four measures of social status are used: level of education, years of education, housing tenure, and the Office of Population Censuses and Surveys' definition of social class based on occupation. By each of these four criteria, and for both sexes, the least advantaged have a significantly higher coronary heart disease prevalence (P less than 0.01). The odds ratios for housing tenure are highest, being 1.63 and 1.55 for men and women, respectively, comparing those who live in rented accommodation with owner-occupiers. After adjustment for a number of coronary heart disease risk factors, which are possible confounding variables, most, if not all, of the significant effect of education and occupation on coronary heart disease is removed. Housing tenure is still highly significant (P less than 0.001), with odds ratios of 1.48 and 1.45 for men and women, respectively. Smoking and fibrinogen are the most important confounding variables for men, and body mass index, high-density lipoprotein cholesterol, and triglyceride levels, the most important for women. When relationships among the social factors themselves are investigated, housing tenure is found to remove the significant effects of education and occupation in men, and of education in women. No other social factor removes the significant effect of housing tenure (P less than 0.001). Housing tenure in Scotland is thus found to be the most discriminatory measure of social status in relation to coronary heart disease.     

Relationship of clinical diabetes and asymptomatic hyperglycemia to risk of coronary heart disease mortality in men and women

This epidemiologic study explored the sex differential in risk of death from coronary heart disease in persons with or without clinically diagnosed diabetes or asymptomatic hyperglycemia. Use was made of 9-year follow-up data from the Chicago Heart Association Detection Project in Industry for 11,220 white men and 8,030 white women aged 35-64 years at entry to the Project (November 1967-January 1973). Both clinically diagnosed diabetes and asymptomatic hyperglycemia were associated with an increased risk of death from coronary heart disease. The extent of this association was greater in women than in men in regard to relative risk. However, absolute excess risk for both diabetics and those with asymptomatic hyperglycemia was larger for men than for women. Clinical diabetes appeared to be an independent risk factor for coronary heart disease in both men and women based on multivariate Cox regression analyses. On the other hand, for men, no significant independent effect of asymptomatic hyperglycemia was apparent. Women with asymptomatic hyperglycemia had significantly higher coronary heart disease death rates than normoglycemic women, with adjustment for major coronary heart disease risk factors; in multivariate analyses, the relationship of asymptomatic hyperglycemia to risk of coronary heart disease was of borderline significance (p = 0.054). This study indicates the independent associations of diabetes and possibly asymptomatic hyperglycemia with coronary heart disease mortality, with greater relative significance in women than in men.     

Tea consumption and the prevalence of coronary heart disease in Saudi adults: results from a Saudi national study

BACKGROUND: The aim of the study was to determine whether there was a relationship between tea consumption and the prevalence of coronary heart disease (CHD) in Saudi Arabia. METHODS: The relationship between tea consumption and the prevalence of CHD was investigated using multiple logistic regression analysis in the Saudi Coronary Artery Disease Study. A total of 3,430 men and women aged 30-70 years was studied. RESULTS: Of the 3,430 subjects who were assigned a category, 6.3% were classified as having indications of CHD. Those who did drink more than 6 cups of tea (>480 mL) per day had a significantly lower prevalence of CHD than the nontea drinkers (P < 0.001). Adjustments for risk factors including age, gender, occupation, education, smoking, family history, blood lipids, diabetes, blood pressure, BMI, physical activity, and coffee and fat intake did not remove the significance (OR = 0.49; 95% CI = 0.24-0.96). There was a positive dose-response effect between tea consumption and CHD (P < 0.001) that was persistent after adjustment for various risk factors (P = 0.022). CONCLUSIONS: These findings support a potential protective effect of tea consumption in relation to CHD in this Saudi study in which all tea consumed was black tea.     

The Scottish Heart Health Study. Dietary intake by food frequency questionnaire and odds ratios for coronary heart disease risk. II. The antioxidant vitamins and fibre.

High serum antioxidant vitamins are increasingly being associated with reduced risk of coronary heart disease (CHD). Previous studies have not addressed the relationship between dietary antioxidant vitamins and risk of CHD although diet is a key factor which modifies blood antioxidant vitamin levels. In prospective studies, high-fibre diets have also been associated with reduced CHD incidence. In this analysis CHD-diagnosed, -undiagnosed and non-CHD controls were selected from 10,359 men and women aged 40-59 who participated in a cross-sectional study of CHD risk factors. Diet was assessed by food frequency questionnaire, odds ratios were adjusted for the classical CHD risk factors (+/- social class) and calculated relative to the first quintile for each vitamin and total fibre. The antioxidant vitamins were further combined in a principal component analysis and the odds ratios for undiagnosed and diagnosed CHD were again calculated. For undiagnosed CHD, risk was significantly lower in the highest quintiles of beta-carotene, fibre and vitamin C, E and A for men, but only lower for fibre in women. Opposite trends were observed in the odds ratios for vitamin C and E and fibre for male-diagnosed CHD which possibly indicates changes in diet as a result of diagnosis. Principal component analysis showed significantly reduced risk of undiagnosed CHD in the top three quintiles for men (odds ratios 0.66, 0.67 and 0.64; P less than 0.05 in each case). A similar trend occurred for women but was non-significant. The results suggest that high dietary intake of the antioxidant vitamins may reduce risk of CHD, particularly in men, and that fibre may be equally cardio-protective in both sexes.     

The gender gap in heart disease: lessons from Eastern Europe

Why are men more susceptible to heart disease than women? Traditional risk factors cannot explain the gender gap in coronary heart disease (CHD) or the rapid increase in CHD mortality among middle-aged men in many of the newly independent states of Eastern Europe. However, Eastern European men score higher on stress-related psychosocial factors than men living in the West. Comparisons between the sexes also reveal differences in psychosocial and behavioral coronary risk factors favoring women, indicating that women's coping with stressful events may be more cardioprotective. Men's greater susceptibility to heart disease, particularly observable in many Eastern European countries, poses unique threats to public health and points to solutions in the behavioral and social arena.     

Risk factors for coronary heart disease in African American women.

There have been few studies of risk factors for coronary heart disease in African American women. The authors investigated factors associated with prevalent coronary heart disease in data provided by participants in the Black Women's Health Study. In 1995, 64,530 US Black women aged 21-69 years completed postal health questionnaires. The 352 women who reported having had a heart attack (cases) were frequency matched 5:1 on age with 1,760 women who had not (controls); medical record review for 35 cases indicated that two-thirds had had a heart attack and the remainder had other coronary heart disease. Odds ratios, obtained from multiple logistic regression analyses, were significantly elevated for cigarette smoking, drug-treated hypertension, drug-treated diabetes mellitus, elevated cholesterol level, and history of heart attack in a parent. High body mass index (kg/m2) was associated with coronary heart disease in the absence of control for hypertension, diabetes mellitus, and elevated cholesterol but not when they were controlled, suggesting that obesity may influence risk as a result of its effects on blood pressure, glucose tolerance, and cholesterol levels. Odds ratios increased with increasing parity and with decreasing age at first birth. These data suggest that important risk factors for coronary heart disease are similar in Black women and White women.     

Small area statistics as markers for personal social status in the Scottish heart health study.

OBJECTIVE: To evaluate a deprivation index, calculated from small area statistics for postcode sectors, as a measure of individual social status in an epidemiological study of coronary heart disease (CHD). DESIGN: A baseline, cross sectional survey. SETTING: Twenty two local authority districts of Scotland surveyed between 1984 and 1986. SUBJECTS: A total of 10359 men and women aged 40-59 years randomly selected to the Scottish heart health study. MAIN RESULTS: The Scottish deprivation categorisation, derived from small area statistics, exhibits a strong linear trend (p = 0.001 or below) for individual prevalent CHD for men and women, unadjusted, and adjusted for major cardiovascular risk factors. The degree of association with CHD is similar to that for measures of social class based upon occupation. CONCLUSIONS: The Scottish deprivation categorisation is an effective measure of individual social status in the current study, broadly comparable in its effect with the more traditional classification derived from occupations. The latter has important problems in definition, especially for women. Small area statistics may provide a useful marker of individual social status in a more general epidemiological setting.     

Prevalence of cardiovascular disease risk factors in blacks and whites: the Minnesota Heart Survey.

Two cross-sectional surveys were conducted in 1985 and 1986 to measure the prevalence of coronary heart disease (CHD) risk factors in Blacks and Whites. A home interview was followed by a survey center visit. Participation rates were 78 per cent and 90 per cent for the home interview and 65 per cent and 68 per cent for the survey center visit. Adjusted for age and education, systolic and diastolic blood pressure was 3 to 4 mmHg higher in Blacks. Hypertension was more prevalent in Blacks than Whites (44 per cent vs 28 per cent); serum total cholesterol was approximately 0.4 mmol/l lower in Black than White men and 0.08 mmol/l lower in Black than White women. Among men, more Blacks than Whites were current cigarette smokers (44 per cent vs 30 per cent); however, White smokers smoked more cigarettes per day (26 vs 17). Similar differences were noted for women, although the prevalence and quantity of cigarette consumption was less than men. The excess prevalence of these CHD risk factors in Blacks, especially among women, may explain their elevated CHD and stroke mortality rates in the Twin Cities.     

Gender differences in clinical status at time of coronary revascularisation in Spain

OBJECTIVE: To study gender differences in clinical status at the time of coronary revascularisation. DESIGN: Retrospective study of clinical records. Two stage stratified cluster sampling was used to select a nationally representative sample of patients receiving a coronary revascularisation procedure in 1997. SETTING: All of Spain. MAIN OUTCOME MEASURES: Odds ratios (OR) in men and women for different clinical and diagnostic variables related with coronary disease. A logistic regression model was developed to estimate the association between coronary symptoms and gender. RESULTS: In the univariate analysis the prevalence of the following risk factors for coronary heart disease was higher in women than in men: obesity (OR=1.8), hypertension (OR=2.9) and diabetes (OR=2.1). High surgical risk was also more prevalent among women (OR=2.6). In the logistic regression analysis women's risk of being symptomatic at the time of revascularisation was more than double that of men (OR=2.4). CONCLUSIONS: Women have more severe coronary symptoms at the time of coronary revascularisation than do men. These results suggest that women receive revascularisation at a more advanced stage of coronary disease. Further research is needed to clarify what social, cultural or biological factors may be implicated in the gender differences observed.     

Consumption of Dairy Products and Death From Cardiovascular Disease in the Japanese General Population: The NIPPON DATA80

Background

Recent Western studies show an inverse association between milk and dairy product intake and cardiovascular disease (CVD). We studied the association between consumption of milk and dairy products and CVD death in Japan.

Methods

Men and women aged 30 years or older were followed for 24 years. All had participated in a national nutrition survey in 300 health districts throughout Japan in 1980. The Cox proportional hazards model was used to assess mortality risk according to tertiles of milk and dairy product intake, with the high consumption group as reference. Hazard ratios (HRs) per 100-g/day increase in consumption were also estimated.

Results

During the 24-year follow-up period, there were 893 CVD deaths, 174 deaths from coronary heart disease (CHD), and 417 stroke deaths among 9243 participants. For women, the HRs for death from CVD, CHD, and stroke in the low consumption group were 1.27 (95% CI: 0.99–1.58; P for trend = 0.045), 1.67 (0.99–2.80; P = 0.02), and 1.34 (0.94–1.90; P = 0.08), respectively, after adjustment for age, body mass index, smoking status, alcohol drinking habits, history of diabetes, use of antihypertensives, work category, and total energy intake. With each 100-g/day increase in consumption of milk and dairy products, HRs tended to decrease for deaths from CVD (HR, 0.86; 95% CI, 0.74–0.99), CHD (0.73; 0.52–1.03), and stroke (0.81; 0.65–1.01) in women. No significant association was observed in men.

Conclusions

Consumption of milk and dairy products was inversely associated with CVD death among women in Japan.Key words: dairy products, cardiovascular disease, mortality, blood pressure, coronary heart disease     

Dietary intake and the risk of coronary heart disease among the coconut-consuming Minangkabau in West Sumatra, Indonesia

Several nutrition and non-nutritional pathways are recognised in the development and occurrence of cardiovascular disease. In many populations, high intakes of saturated fat are associated with elevated serum cholesterol concentrations and increased coronary heart disease (CHD) mortality. However, several studies report that hyperlipidaemia and heart diseases are not common among populations who consume coconut, a source of saturated fat. A case-control study was conducted among the Minangkabau known to be high coconut consumers to examine the difference in food patterns and risk of coronary heart disease (CHD) between the coronary cases and their gender- and age-matched apparently healthy counterparts serving as controls. Eligible subjects with CHD were identified through the co-operation of five participating hospitals located in Padang and Bukittinggi in West Sumatra, Indonesia. A total of 93 eligible cases (62 men and 31 women) in the Case group and 189 subjects (113 men and 76 women) in the Control group were recruited. Information on the intakes of individual foods and dishes over the preceding 12 months was obtained using a semi-quantitative food frequency questionnaire. The Case groups had significantly higher intakes of meats, eggs, sugar, tea, coffee and fruits, but lower intakes of soy products, rice and cereals compared to the controls. Coconut consumption as flesh or milk was not different between cases and controls. The cases had significantly higher intakes of protein and cholesterol, but lower intake of carbohydrate. Similar intakes of saturated and unsaturated fatty acids between the cases and controls indicated that the consumption of total fat or saturated fat, including that from coconut, was not a predictor for CHD in this food culture. However, the intakes of animal foods, total protein, dietary cholesterol and less plant derived carbohydrates were predictors of CHD.     

Depression as a predictor of hospitalization due to coronary heart disease

BACKGROUND: Studies have shown that patients with depression have higher rates of coronary heart disease (CHD) than people in the general population. However, large-scale population-based data on incidence rates of CHD in people with depression are needed. This study analyzed whether hospitalization for depression predicts CHD in men and women after accounting for socioeconomic status and geographic region. METHODS: Data from the family coronary heart disease database at the Karolinska Institute, Stockholm, were used to identify all people in Sweden aged 25 to 64 at onset of depression and aged 25 to 79 at onset of nonfatal CHD during the study period (1987 to 2001). Standardized incidence ratios (SIRs) of CHD among those with and without depression were compared. All analyses were conducted in 2005. RESULTS: There were 1767 cases of CHD among those with depression during the study period. The risk of developing CHD was strongest for those aged <40; the SIR was 2.17 (95% confidence interval [CI]=1.50-3.03). The risk was attenuated with increasing age in both men and women. People aged 70 to 79 at onset of depression did not have an increased risk of CHD. CONCLUSIONS: Even after accounting for socioeconomic status and geographic region, depression is a clinically significant risk factor for developing CHD, especially in men and women aged 25 to 50. Primary healthcare teams should make particular efforts to identify young to middle-aged women and men who have depression, especially in combination with other CHD risk factors.     

Serum uric acid and risk of coronary heart disease: Atherosclerosis Risk in Communities (ARIC) Study

PURPOSE: Approximately half of previous studies on serum uric acid have reported it to be an independent risk factor for coronary heart disease (CHD). We tested this hypothesis in the Atherosclerosis Risk in Communities (ARIC) Study. METHODS: A total of 13,504 healthy middle-aged men and women were followed prospectively for up to eight years. We identified 128 fatal and nonfatal CHD events in women and 264 in men. RESULTS: The age-, race-, and ARIC field center-adjusted relative risk of CHD for sex-specific quartiles of serum uric acid were 1.0, 1.39, 1.08, and 2.35 in women (p for trend = 0.009) and 1.0, 1.03, 0.89, and 1.21 in men (p for trend = 0.44), respectively. However, serum uric acid was correlated positively with many risk factors, and after multivariable adjustment, there was little evidence of an association of uric acid with CHD in either sex. CONCLUSIONS: Our results are not consistent with serum uric acid being an independent risk factor for CHD.