Morbidity and mortality of myocardial infarction in the MONICA study area Augsburg in 1985

Summary In the year 1985, 998 (734 men, 264 women) cases of acute coronary events were registered among the 25–74 year-old residents of the study area (151,489 men and 171,093 women) of whom 583 (403 men, 180 women) died within 28 days (case fatality). Both AMI as a clinical diagnosis and AMI as a cause of death are validated by defined MONICA diagnostic criteria (acute symptoms, enzyme level, ECG, autopsy diagnosis). The AMI-risk (MONICA diagnostic categories 1, 2, 3, 9) in the study area Augsburg is relatively low (incidence: men 302, women 113; attack rate: men 444, women 138; death rate: men 241, women 92; all per 100,000 for each group). The 28-day case fatality is comparatively high (men 54%, women 67%). A comparison of the Augsburg rates with those of three other centers shows that the Augsburg figures are in the lower range.

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Morbidität und Mortalität an akutem Herzinfarkt in der MONICA Studienregion Augsburg im Jahre 1985

Zusammenfassung Im Jahre 1985 wurden 998 (734 Männer, 264 Frauen) Herzinfarkterkrankungsfälle bei 25- bis 74jährigen Einwohnern der Studienregion (151489 Männer und 171093 Frauen) registriert, von denen 583 Personen (403 Männer und 180 Frauen) innerhalb von 28 Tagen verstarben. Die klinische Diagnose Herzinfarkt und auch die Todesursache «Koronare Herzkrankheit» wurden anhand der MONICA-Diagnose-Kriterien (akute Symptomatik, Enzymhöhe, EKG-Verlauf und bei Verstorbenen das Autopsieergebnis) validiert und nach MONICA-Diagnose-Kategorien eingeteilt. Ein erster Vergleich mit 3 weiteren MONICA-Zentren zeigt deutlich regionale Differenzen bei den «attack-rates» und der 28-Tage-Letalität, während die Herzinfarktmortalität weniger differiert. Die Herzinfarkterkrankungs- und sterbehäufigkeit der 25- bis 74jährigen Studienbevölkerung ist relativ niedrig (Erstinfarkthäufigkeit: 302 für Männer, 113 für Frauen; Fallhäufigkeit: 444 für Männer, 138 für Frauen; Sterberate: 241 für Männer, 92 für Frauen; jeweils je 100000 der Bevölkerung gleichen Geschlechts). Die 28-Tage-Letalität ist mit 54% der männlichen und 67% der weiblichen Herzinfarkterkrankten vergleichsweise hoch.

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Morbidité et mortalité par l'infarctus du myocarde dans la région MONICA d'Augsburg en 1985

Résumé Chez les habitants de la région augsbourgeoise âgés de 25 à 74 ans (151489 hommes et 171093 femmes), 998 cas (734 hommes, 264 femmes) de malades de l'infarctus du myocarde ont été recensés, dont 583 (403 hommes et 180 femmes) sont décédés en 28 jours. Le diagnostic clinique de l'infarctus du myocarde aussi bien que la cause du décès par «cardiopathie coronaire» ont été évalués et classés à l'aide de catégories diagnostiques MONICA (symptÔmes aigus, taux d'enzyme, tracés-électrocardiographe et les résultats de l'autopsie des décédés). Une première comparaison avec trois autres centres MONICA présente une différence régionale nette en ce qui concerne la fréquence des crises cardiaques et la létalité de 28 jours, tandis qu'elle est moins prononcée quant à la mortalité par infarctus du myocarde. La maladie de l'infarctus et les décès qui en résultent sont relativement peu fréquents dans une population âgée de 25 à 74 ans (fréquence du premier infarctus: 302 hommes, 113 femmes; fréquence de cas: 444 hommes, 138 femmes; Taux de décès par infarctus du myocarde: 241 hommes, 92 femmes; sur 100000 respectivement d'une population du même sexe). La létalité de 28 jours représente un taux relativement élevé avec 54% des hommes et 67% des femmes malades de l'infarctus.

     

Self-rated health and its relation to all-cause and cardiovascular mortality in southern Germany. Results from the MONICA Augsburg cohort study 1984-1995

PURPOSE: Studies worldwide show that self-rated health (SRH) is a robust predictor of mortality among the elderly. Only few studies have focussed on a middle-aged population and no such study has been reported from Germany. This study examined the association between SRH and mortality in a middle-aged, population based cohort from Germany, using data from the MONICA (Monitoring Trends and Determinants in Cardiovascular Diseases) Augsburg project. METHODS: The cohort comprises 1521 men and 1498 women aged 35-64; they were followed over 11 years from 1984-1995. Participants provided extensive data on medical conditions and cardiovascular risk factors through interviews and examinations. SRH was assessed globally and in comparison to those of the same age. We estimated relative hazards for mortality from all-causes and cardiovascular disease according to self-ratings of health. RESULTS: Among males the adjusted hazards rate ratio (HRR) of mortality from all-causes was 1.5 (95% CI 1.1-2.2) for combined fair/poor perceived health compared with good/excellent health. Women with fair/poor ratings had no increased risk of dying (HRR = 1.1, 95% CI 0.7-1.9). Men who perceived worse health than persons of the same age showed an adjusted HRR of 1.7 (95% CI 1.0-2.9) as compared to those perceiving better health; in women the adjusted HRR was 1.9 (95% CI 1.0-3.7). The adjusted hazards for dying from cardiovascular diseases in men were 1.3 (95% CI 0.8-2.1) for those perceiving fair/poor and 1.7 (95% CI 0.7-3.7) for those perceiving worse health. CONCLUSIONS: Self-rated health was a predictor of mortality in a middle-aged German population and contains information that is not entirely reflected in underlying medical conditions and risk factors. Self-assessments of health in comparison to individuals of the same age were stronger and more consistently associated with mortality. Global self-ratings of health and self-ratings in comparison to those of the same age may measure slightly different dimensions and the effect of self-rated health may differ among men and women.     

Morbidity and mortality of myocardial infarction in the Augsburg MONICA study area in 1985, 1986 and 1987

In the years 1985, 1986 and 1987, the MONICA Augsburg Coronary Event Register recorded 1488 coronary events (1214 men and 274 women) occurring in 35-64 year old residents of the study region (population: 102,000 men and 105,000 women). The rates presented include all coronary events with a definite acute myocardial infarct (AMI), possible AMI, resuscitated cardiac arrest, and insufficient data. The age-standardized attack rates in men are 390 (1985) to 372 (1987) and in women 51 (1985) to 72 (1987) per 100,000 population. The age-standardized 28-day case fatalities in men are 44 (1985) to 44 (1987) and in women 67 (1985) to 55 (1987) per 100 coronary events. With the exception of the attack rates in women, no statistically significant differences between yearly rates could be established.     

Association of neighborhood physical activity opportunities with incident cardiovascular disease in the Cardiovascular Health Study

We determined associations of cumulative exposures to neighborhood physical activity opportunities with risk of incident cardiovascular disease (CVD). We included 3595 participants from the Cardiovascular Health Study recruited between 1989 and 1993 (mean age = 73; 60% women; 11% black). Neighborhood environment measures were calculated using Geographic Information Systems (GIS) and annual information from the National Establishment Time Series database, including the density of (1) walking destinations and (2) physical activity/recreational facilities in a 1- and 5-km radius around the respondent's home. Incident CVD was defined as the development of myocardial infarction, stroke, or cardiovascular death and associations with time to incident CVD were estimated using Cox proportional hazards models. A total of 1986 incident CVD cases occurred over a median follow-up of 11.2 years. After adjusting for baseline and time-varying individual and neighborhood-level confounding, a one standard deviation increase in walking destinations and physical activity/recreational facilities within 5 km of home was associated with a respective 7% (95% confidence interval (CI) = 0.87–0.99) and 12% (95% CI = 0.73–1.0) decreased risk of incident CVD. No significant associations were noted within a 1-km radius. Efforts to improve the availability of physical activity resources in neighborhoods may be an important strategy for lowering CVD.     

青少年血尿酸水平与心血管代谢危险因子的相关性分析

了解青少年血尿酸水平与心血管代谢危险因子的相关性,为预防儿童高尿酸血症,降低心血管疾病的风险提供参考依据.方法 以哈尔滨市城区1 640名10 ~ 18岁中小学生为研究对象,对其进行体格检查,并测定血尿酸(SUA)、三酰甘油(TG)、胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)等.结果 高尿酸血症的检出率为23.0% (377/1 640),男生为29.7% (242/816),女生为16.4% (135/824),男生检出率高于女生(x2=40.80,P<0.05).不同性别中小学生心血管代谢危险因子的患病率差异均有统计学意义,高血糖、低HDL-C以及超重或肥胖的患病率均为男生高于女生(x2值分别为10.101,2.829,24.602,P值均<0.05).FPG,TG,HDL-C,超重或肥胖以及血压异常组的血尿酸水平均高于其正常组(t值分别为4.003,7.422,5.369,13.340,5.753,P值均<0.05).血尿酸水平与心血管代谢危险因子收缩压(SBP)、舒张压(DBP)、FPG、TG、体质量指数(BMI)均呈正相关(r值分别为0.352,0.127,0.176,0.232,0.441,P值均<0.05),而与HDL-C呈负相关(r=-0.238,P<0.05).将研究对象按SUA水平四分位间距分成4组,随着血尿酸水平的增高,SBP,DBP,FPG,TG,BMI水平随之升高,而HDL-C水平随之降低(P值均<0.05).结论 10 ~18岁青少年血尿酸水平与心血管代谢危险因子存在密切相关性,防治高尿酸血症应从儿童青少年开始.     

Association of green tea consumption with mortality from all-cause,cardiovascular disease and cancer in a Chinese cohort of 165,000 adult men

Tea is the most ancient and popular beverage in the world, and its beneficial health effects has attracted tremendous attention worldwide. However, the prospective evidence relating green tea consumption to total and cause-specific mortality is still limited and inconclusive. We recruited 164,681 male participants free of pre-existing disease during 1990–1991, with green tea consumption and other covariates assessed by the standardized questionnaire and mortality follow up continued until 2006 (mean 11 years; total person-years: 1,961,791). Cox regression analyses were used to quantify the associations of green tea consumption with all-cause (n = 32,700), CVD (n = 11,839) and cancer (n = 7002) mortality, adjusting simultaneously for potential confounders. At baseline, 18 % reported regular consumption of green tea. Compared with non-green tea drinkers, regular drinkers had significantly lower all-cause mortality, with adjusted hazard ratios (HRs) being 0.94 (95 % CI 0.89, 0.99) for ≤5 g/day, 0.95 (0.91, 0.99) for 5–10 g/day and 0.89 (0.85, 0.93) for >10 g/day. For CVD mortality, the corresponding HRs were 0.93 (0.85, 1.01) 0.91 (0.85, 0.98) and 0.86 (0.79, 0.93), respectively, while for cancer they were 0.86 (0.78, 0.98), 0.92 (0.83, 1.00) and 0.79 (0.71, 0.88), respectively. The patterns of these associations varied by smoking, alcohol drinking and locality. This large prospective study shows that regular green tea consumption is associated with significantly reduced risk of death from all-cause, CVD and cancer among Chinese adults.     

Investigation of gender heterogeneity in the associations of serum phosphorus with incident coronary artery disease and all-cause mortality

Serum phosphorus levels in the general population have beenreported to be associated with cardiovascular morbidity andmortality and increased carotid intima-media thickness. Theauthors examined gender heterogeneity in the association ofphosphorus with all-cause mortality and incident coronary arterydisease using data from the Atherosclerosis Risk in CommunitiesStudy (1987–2001). Baseline phosphorus levels were higherin women and were associated differently among men and womenwith traditional atherosclerosis risk factors such as age, lowdensity lipoprotein cholesterol, diabetes mellitus, and hypertension.In a multivariable-adjusted model, men in the highest quintileof serum phosphorus level (>3.8 mg/dL) had an increased mortalityrate (hazard ratio = 1.45, 95% confidence interval: 1.12, 1.88),while women did not (hazard ratio = 1.18, 95% confidence interval:0.89, 1.57). The multivariable likelihood ratio test of effectmodification by gender was significant at = 0.1 (P = 0.085)for all-cause mortality. Although the associations of phosphoruswith coronary artery disease also appeared to differ substantiallyby gender, the multivariable test for effect modification suggestedthat the difference was consistent with random variation (P= 0.195). These results suggest the need for further investigationinto gender differences in the contribution of mineral metabolismto cardiovascular disease in the general population. cardiovascular diseases; coronary artery disease; mortality; phosphorus; risk; sex factors     

Dipstick proteinuria as a predictor of all-cause and cardiovascular disease mortality in Bangladesh: A prospective cohort study

ObjectiveBaseline, persistent, incident, and remittent dipstick proteinuria have never been tested as predictors of mortality in an undeveloped country. The goal of this study was to determine which of these four types of proteinuria (if any) predict mortality.MethodsBaseline data was collected from 2000 to 2002 in Bangladesh from 11,121 adults. Vital status was ascertained over 11–12 years. Cox models were used to evaluate proteinuria in relation to all-cause and cardiovascular disease (CVD) mortality. CVD mortality was evaluated only in those with baseline proteinuria. Persistent, remittent, and incident proteinuria were determined at the 2-year exam.ResultsBaseline proteinuria of 1 + or greater was significantly associated with all-cause (hazard ratio (HR) 2.87; 95% C.I., 1.71–4.80) and CVD mortality (HR: 3.55; 95% C.I., 1.81–6.95) compared to no proteinuria, adjusted for age, gender, arsenic well water concentration, education, hypertension, BMI, smoking, and diabetes mellitus. Persistent 1 + proteinuria had a stronger risk of death, 3.49 (1.64–7.41)-fold greater, than no proteinuria. Incident 1 + proteinuria had a 1.87 (0.92–3.78)-fold greater mortality over 9–10 years. Remittent proteinuria revealed no increased mortality.ConclusionsBaseline, persistent, and incident dipstick proteinuria were predictors of all-cause mortality with persistent proteinuria having the greatest risk. In developing countries, those with 1 + dipstick proteinuria, particularly if persistent, should be targeted for definitive diagnosis and treatment. The two most common causes of proteinuria to search for are diabetes mellitus and hypertension.     

Changes in physical activity in leisure time and the risk of myocardial infarction, ischemic heart disease, and all-cause mortality

Physical activity is associated to a lower risk of mortality from all-causes and from coronary heart disease. The long-term effects of changes in physical activity on coronary heart disease are, however, less known. We examined the association between changes in leisure time physical activity and the risk of myocardial infarction (MI), ischemic heart disease (IHD), and all-cause mortality as well as changes in blood pressure in 4,487 men and 5,956 women in the Copenhagen City Heart Study. Physical activity was measured in 1976–1978 and 1981–1983 and participants were followed in nation-wide registers until 2009. Men who decreased physical activity by at least two levels and women who decreased by one level had a higher risk of MI relatively to an unchanged physical activity level (hazard ratio [HR] = 1.74, 95% confidence interval [95% CI]: 1.17–2.60 and HR = 1.30, 95% CI: 1.03–1.65). Similar associations were found for IHD although only significant in women. In all-cause mortality, men who increased physical activity had a lower risk and both men and women who reduced physical activity had a higher risk compared to an unchanged physical activity level. No association between changes in physical activity and blood pressure was observed. Findings from this prospective study suggest that changes in physical activity affect the risk of MI, IHD and all-cause mortality. A decrease in physical activity was associated to a higher risk of coronary heart disease.     

银川市儿童青少年血清尿酸水平与心血管危险因素及其聚集的关系

目的探讨银川市儿童青少年血清尿酸水平与心血管危险因素以及心血管危险因素聚集(cardiovascular risk factor clustering, CVRFC)的关系。方法采取现况研究的设计,以分层整群抽样的方法于2015年、2017—2018年抽取银川市城区1486名10～18岁儿童青少年作为研究对象,年龄(14.3±1.4)岁,其中包括男生728人(49.0%),汉族1157人(77.9%),回族170人(11.4%),其他民族159人(10.7%)。所有研究对象均完成问卷调查、体格测量和生化检验。二元Logistics回归分析高尿酸血症(hyperuricemia, HUA)和性别与心血管危险因素及CVDRF≥2和CVDRF≥3的关联强度。结果调整混杂因素后,HUA与腹型肥胖(OR=3.23,95%CI 2.37～4.40)、高血压(OR=1.64,95%CI 1.21～2.23)、血脂异常(OR=1.51,95%CI 1.17～1.96)、CVRFC≥2(OR=3.71,95%CI 2.80～4.93)及CVRFC≥3 (OR=6.92,95%CI 4.18～11.64)...     

Reliability of data from proxy respondents in an international case-control study of cardiovascular disease and oral contraceptives. World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception.

STUDY OBJECTIVES: To evaluate the reliability of data supplied in a case-control study by proxy respondents for cases who were too ill to do so themselves. DESIGN: A hospital based, case-control study of the current use of oral contraceptives (OC) and cardiovascular diseases. Data from "true" controls matched to a subset of cases were compared with those supplied by proxy respondents about the true controls. SETTING: Hospitals in 21 centres from Africa, Asia, Europe, and Latin America. PATIENTS AND PARTICIPANTS: For a subset of cases, 403 pairs of controls-one "true" and one proxy-were interviewed. "True" controls were matched by age, place, and time of admission and were admitted with 1 of 27 permissible diagnoses not associated with OC use. Proxy controls were either relatives or friends of true controls. MAIN RESULTS: Levels of concordance between data from proxy and true controls were high for most variables regarding recent events, including current OC use, but were greatly diminished when detailed information, particularly from the past, was required. Husbands were usually the best proxy, although this was question-specific. The sensitivity and specificity of proxy responses were 93% (95% confidence intervals: 77%, 99%) and 100% (98%, 100%) respectively, for current use of OC. Assuming the misclassification of current OC use by proxy cases is similar to that produced by proxy controls, the estimated impact of using proxy data on risk estimates associated with current OC use was to bias the overall estimate of risk of stroke by less than 3% and the risks of both acute myocardial infarction and venous thromboembolism by less than 1%. CONCLUSIONS: Friends or relatives, and particularly husbands, provided reliable information when used as proxy respondents for young women. The estimated impact of misclassification by proxy respondents on overall risk estimates in the WHO collaborative study was less than that which would have arisen if information from proxy respondents had not been used.     

Association of visceral adipose tissue with incident myocardial infarction in older men and women: the Health, Aging and Body Composition Study

Assessment of body fat distribution, particularly visceral adipose tissue, may be important for accurate risk evaluation for cardiovascular disease in the elderly. This 1997-1998 US study examined the association of incident myocardial infarction (MI) with total adiposity (body mass index and fat mass) and body fat distribution (waist-to-thigh ratio, waist circumference, visceral and subcutaneous adipose tissue) in well-functioning men (n = 1,116) and women (n = 1,387) aged 70-79 years enrolled in the Health, Aging and Body Composition Study. There were 116 MI events (71 in men, 45 in women) during an average follow-up time of 4.6 (standard deviation, 0.9) years. No association was found between incident MI and the adiposity or fat distribution variables for men. For women, visceral adipose tissue was an independent predictor of MI (hazard ratio = 1.67, 95% confidence interval: 1.28, 2.17 per standard-deviation increase; p < 0.001). No association was found between body mass index or total fat mass and MI events in women. The association of visceral adipose tissue with MI in women was independent of high density lipoprotein cholesterol, interleukin-6 concentration, hypertension, and diabetes (hazard ratio = 1.79, 95% confidence interval: 1.24, 2.58 per standard-deviation increase; p < 0.01). The amount of adipose tissue stored in the intraabdominal cavity is an important, independent risk factor for MI in well-functioning, elderly women.     

Validation of reported myocardial infarction mortality in blacks and whites. A report from the Community Cardiovascular Surveillance Program.

It is widely believed that blacks experience a higher mortality due to coronary heart disease (CHD) than do whites. To determine whether this reported difference in mortality between blacks and whites is real, we studied the question in the context of the Community Cardiovascular Surveillance Program (CCSP). Fatal and nonfatal cases of CHD were reviewed in 12 US communities. Standardized criteria were applied to classify these cases as possible CHD, definite CHD, possible myocardial infarction (MI), or definite MI. The annual age-adjusted mortality rate per 100,000 ascribed to definite MI by the CCSP criteria was higher in blacks than in whites: 47 in white men (95% confidence interval, 36 to 58), 18 in white women (95% confidence interval, 8 to 28), 95 in black men (95% confidence interval, 10 to 180), and 41 for black women (95% confidence interval, 0 to 99). The proportion of definite MI to all fatal CHD events was higher in blacks (16%) than in whites (12%). For nonfatal events, however, the rate of definite MI was higher in whites than in blacks: 322 in white men (95% confidence interval, 293 to 351), 225 in black men (95% confidence interval, 160 to 290), 82 in black women (95% confidence interval, 43 to 121), and 103 in white women (95% confidence interval, 88 to 118). The proportion of definite MI to all nonfatal CHD events was lower in blacks (16%) than in whites (30%). Thus, the overall rate for fatal and nonfatal definite MI was lower in blacks (215/100,000) than in whites (244/100,000). These observations suggest that a combination of high case-fatality ratio and misclassification of cause and death may contribute to the reported higher rate of CHD mortality among blacks.     

Trends in dietary sources of nutrients among middle-aged men in southern Germany. Results of the MONICA Project Augsburg: dietary surveys 1984/1985 and 1994/1995. MONItoring trends and determinants in CArdiovascular disease

The study analyses 10-year trends (1984/1985-1994/1995) in southern Germany in the food sources of nutrients. In two phases of the MONICA Project in Augsburg, dietary surveys were conducted in subsamples of 45 to 64 year-old men. Responses in 1984/1985 and 1994/1995 were 69.8% and 70.8% with eligible samples of 603 and 607, respectively. Seven-day records were collected and coded with the German food composition database. Percentage contribution of food groups to selected nutrient intakes were calculated. Meat and meat products and eggs decreased in importance as contributors to the intake of energy and several nutrients, whereas fish and fish products, milk and milk products and various food groups of plant origin became more important. In 1984/1985, for instance, meat and meat products delivered 23.4% of energy, 47.5% of protein and 38.1% of fat, whereas in 1994/1995 the respective contributions declined to 21.4%, 44.0% and 34.5%. The new product group of supplements has already become an important contributor to the intake of vitamin C. Both static intakes and changes in intake of certain nutrients can be explained by corresponding fluctuations in patterns of intake of the underlying food sources. Therefore it is recommended that dietary assessments use food source lists derived from the most recent dietary surveys.     

n-3 Polyunsaturated fatty acids,fatal ischemic heart disease,and nonfatal myocardial infarction in older adults: the Cardiovascular Health Study

BACKGROUND: Little is known about the relation of the dietary intake of n-3 polyunsaturated fatty acids, ie, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) from fatty fish and alpha-linolenic acid from vegetable oils, with ischemic heart disease among older adults. OBJECTIVE: We investigated the associations of plasma phospholipid concentrations of DHA, EPA, and alpha-linolenic acid as biomarkers of intake with the risk of incident fatal ischemic heart disease and incident nonfatal myocardial infarction in older adults. DESIGN: We conducted a case-control study nested in the Cardiovascular Health Study, a cohort study of adults aged > or = 65 y. Cases experienced incident fatal myocardial infarction and other ischemic heart disease death (n = 54) and incident nonfatal myocardial infarction (n = 125). Matched controls were randomly selected (n = 179). We measured plasma phospholipid concentrations of n-3 polyunsaturated fatty acids in blood samples drawn approximately 2 y before the event. RESULTS: A higher concentration of combined DHA and EPA was associated with a lower risk of fatal ischemic heart disease, and a higher concentration of alpha-linolenic acid with a tendency to lower risk, after adjustment for risk factors [odds ratio: 0.32 (95% CI: 0.13, 0.78; P = 0.01) and 0.52 (0.24, 1.15; P = 0.1), respectively]. In contrast, n-3 polyunsaturated fatty acids were not associated with nonfatal myocardial infarction. CONCLUSIONS: Higher combined dietary intake of DHA and EPA, and possibly alpha-linolenic acid, may lower the risk of fatal ischemic heart disease in older adults. The association of n-3 polyunsaturated fatty acids with fatal ischemic heart disease, but not with nonfatal myocardial infarction, is consistent with possible antiarrhythmic effects of these fatty acids.