Type 2 diabetes as a "coronary heart disease equivalent": an 18-year prospective population-based study in Finnish subjects

OBJECTIVE: The purpose of this study was to investigate the hypothesis that coronary heart disease (CHD) mortality in diabetic subjects without prior evidence of CHD is equal to that in nondiabetic subjects with prior myocardial infarction or any prior evidence of CHD. RESEARCH DESIGN AND METHODS: During an 18-year follow-up total, cardiovascular disease (CVD) and CHD deaths were registered in a Finnish population-based study of 1,373 nondiabetic and 1,059 diabetic subjects. RESULTS: Adjusted multivariate Cox hazard models indicated that diabetic subjects without prior myocardial infarction, compared with nondiabetic subjects with prior myocardial infarction, had a hazard ratio (HR) of 0.9 (95% CI 0.6-1.5) for the risk of CHD death. The corresponding HR was 0.9 (0.5-1.4) in men and 1.9 (0.6 -6.1) in women. Diabetic subjects without any prior evidence of CHD (myocardial infarction or ischemic electrocardiogram [ECG] changes or angina pectoris), compared with nondiabetic subjects with prior evidence of CHD, had an HR of 1.9 (1.4-2.6) for CHD death (men 1.5 [1.0-2.2]; women 3.5 [1.8-6.8]). The results for CVD and total mortality were quite similar to those for CHD mortality. CONCLUSIONS: Diabetes without prior myocardial infarction and prior myocardial infarction without diabetes indicate similar risk for CHD death in men and women. However, diabetes without any prior evidence of CHD (myocardial infarction or angina pectoris or ischemic ECG changes) indicates a higher risk than prior evidence of CHD in nondiabetic subjects, especially in women.     

High risk strategies for atherosclerosis.

Calculating a person's chances of developing coronary heart disease (CHD) is not simple, as many risk factors interact in a complex fashion. Thus many markers, though significant in univariate comparisons, are no longer so when multivariate analysis is performed. Those factors contributing independently to risk can be identified only in prospective investigations such as the Münster Heart (PROCAM) or the Framingham studies. In the Münster Heart study, follow-up of middle-aged men for eight years identified the following nine independent risk variables: age, smoking history, personal history of angina pectoris, family history of myocardial infarction, systolic blood pressure, raised plasma low density lipoprotein cholesterol (LDL-C), low plasma high density lipoprotein cholesterol, raised fasting plasma triglyceride and presence of diabetes mellitus. These have been used to generate an algorithm for prediction of first coronary events which is available in interactive fashion on the internet'. Large trials have shown that lowering LDL-C reduces the risk of CHD, and diminishes CHD morbidity and mortality in persons without prior evidence of coronary atherosclerosis (primary prevention). This is even more the case in patients with such evidence (secondary prevention). It appears that lowering of LDL-C also reduces all-cause mortality in secondary prevention.     

血浆致动脉硬化指数在绝经后女性冠心病中的预测价值

目的 探讨血浆致动脉硬化指数（atherogenic index of plasma，AIP）在绝经后女性冠心病中的预测价值。方法 采用回顾性分析方法，收集疑诊冠心病于我院住院并行冠状动脉造影的绝经后女性患者233例，根据造影结果分为冠心病组（n=171）和对照组（n=62）。比较两组间AIP的差异；应用二元Logistic回归分析绝经后女性冠心病的独立危险因素，并分析AIP对绝经后女性冠心病的预测价值。结果 冠心病组AIP水平明显高于对照组（P<0.01）。二元Logistic回归分析显示高AIP水平、低雌二醇（E2）、高血压可作为评估绝经后女性冠心病的独立危险因素（OR=8.784，P=0.002，95%CI：2.170~35.558；OR=0.813，P=0.000，95%CI：0.764~0.865；OR=2.151，P=0.037，95%CI：1.046~4.422）。ROC曲线分析校正AIP预测冠心病的最佳临界值是2.02 ，敏感度为66.7%，特异度为64.5%。结论 高AIP水平、低E2可作为绝经后女性冠心病的独立危险因素，AIP可用于预测绝经后女性冠心病，当校正AIP＞2.02时，可认为存在冠心病的风险。     

Risk factors for coronary heart disease in type 1 diabetic patients in Europe: the EURODIAB Prospective Complications Study

OBJECTIVE: The goal of the study was to examine risk factors in the prediction of coronary heart disease (CHD) and differences in men and women in the EURODIAB Prospective Complications Study. RESEARCH DESIGN AND METHODS: Baseline risk factors and CHD at follow-up were assessed in 2,329 type 1 diabetic patients without prior CHD. CHD was defined as physician-diagnosed myocardial infarction, angina pectoris, coronary artery bypass graft surgery, and/or Minnesota-coded ischemic electrocardiograms or fatal CHD. RESULTS: There were 151 patients who developed CHD, and the 7-year incidence rate was 8.0 (per 1,000 person-years) in men and 10.2 in women. After adjustment for age and/or duration of diabetes, the following risk factors were related to CHD in men: age, GHb, waist-to-hip ratio (WHR), HDL cholesterol, smoking, albumin excretion rate (AER), and autonomic neuropathy. The following risk factors were related to CHD in women: age, systolic blood pressure (BP), fasting triglycerides, AER, and retinopathy. Multivariate standardized Cox proportional hazards models showed that age (hazard ratio 1.5), AER (1.3 in men and 1.6 in women), WHR (1.3 in men), smoking (1.5 in men), fasting triglycerides (1.3 in women) or HDL cholesterol (0.74 in women), and systolic BP (1.3 in women) were predictors of CHD. CONCLUSIONS: This study supports the evidence for a strong predictive role of baseline albuminuria in the pathogenesis of CHD in type 1 diabetes. Furthermore, sex-specific risk factors such as systolic BP, fasting triglycerides (or HDL cholesterol), and WHR were found to be important in the development of CHD.     

Should diabetes be considered a coronary heart disease risk equivalent?: results from 25 years of follow-up in the Renfrew and Paisley survey

OBJECTIVE: The purpose of our study was to confirm or refute the view that diabetes be regarded as a coronary heart disease (CHD) risk equivalent and to test for sex differences in mortality. RESEARCH DESIGN AND METHODS: This was a prospective cohort study of 7,052 men and 8,354 women aged 45-64 years from Renfrew and Paisley, Scotland, who were first screened in 1972-1976 and followed for 25 years. All-cause mortality was calculated as death per 1,000 person-years. A Cox proportional hazards model was used to adjust survival for age, smoking habit, blood pressure, serum cholesterol, BMI, and social class. RESULTS: There were 192 deaths in 228 subjects with diabetes and 2,016 deaths in 3,076 subjects with CHD. The highest mortality was in the group with both diabetes and CHD (100.2 deaths/1,000 person-years in men, 93.6 in women) and the lowest in the group with neither (29.2 deaths/1,000 person-years in men, 19.4 in women). Men and women with diabetes only and CHD only formed an intermediate risk group. The adjusted hazard ratio (HR) for CHD mortality in men with diabetes only compared with men with CHD only was 1.17 (95% CI 0.78-1.74; P = 0.56). Corresponding HR for women was 1.97 (1.27-3.08; P = 0.003). CONCLUSIONS: Diabetes without previous CHD carries a lifetime risk of vascular death as high as that for CHD alone. Women may be at particular risk. Our data support the view that cardiovascular risk factors in diabetes should be treated as aggressively as in people with CHD.     

Estimation of seasonal variations in risk factor profiles and mortality from coronary heart disease

OBJECTIVE: Seasonal variations in coronary heart disease (CHD) and related risk factors have been reported previously. However, no studies to date quantify the contribution of seasonal variations in risk factors to actual mortality in both men and women using a single database of sufficient size and follow-up. METHODS: We investigated the database from the Western Austrian Vorarlberg Health Monitoring and Promotion Programme (VHM&PP) including over 450,000 repeated measurements of 149,650 individuals between 1985 and 1999. RESULTS: Of a total of 1266 deaths from CHD (ICD-9 410-414), 353 deaths occurred between December and February (27.9%), in contrast to 275 (21.7%) between June and August. While the frequency of deaths through acute myocardial infarction (ICD-9 410) was similar over the seasons, chronic forms of CHD (ICD-9 414) occurred significantly (p < 0.001) more frequently in winter. Total cholesterol, blood pressure and body mass index showed pronounced seasonal variations with average levels significantly higher during the winter months in all age groups and both sexes, giving an estimated increase in score risk of 6.8% in men and 3.6% in women. However by contrast, use of single time point risk factor data tended to over-estimate subsequent 10 year mortality if measured in winter and the converse in summer. CONCLUSION: For the first time, this study quantifies the contribution of seasonal risk factor variation to CHD mortality. The consistent effect across demographic groups suggests that this is a real physiological phenomenon and not an artefact of living conditions. Interpretation of standard risk scores should take account of this seasonal fluctuation in subsequent investigation and follow-up.     

Migraine and coronary heart disease in women and men

OBJECTIVE: We evaluated migraine as an independent risk factor for subsequent coronary heart disease (CHD) events among women in the Women's Health Study (WHS) and men in the Physicians' Health Study (PHS). BACKGROUND: Although several studies have suggested that migraine is associated with increased risk of stroke, there are few and conflicting data on whether migraine predicts risk of future CHD events. METHODS: The WHS is an ongoing randomized, double-blind, placebo-controlled trial of low-dose aspirin and vitamin E in the primary prevention of cardiovascular disease and cancer in 39876 women health professionals aged > or =45 years in 1993, and the PHS is a completed randomized, double-blind, placebo-controlled trial of aspirin and beta-carotene in the primary prevention of cardiovascular disease and cancer in 22071 men physicians aged 40 to 84 years in 1982. Primary endpoints were defined as major CHD (nonfatal myocardial infarction [MI] or fatal CHD) and total CHD (major CHD plus angina and coronary revascularization). RESULTS: After adjusting for other CHD risk factors, female health professionals and male physicians reporting migraine were not at increased risk for subsequent major CHD (women: relative risk [RR], 0.83; 95% confidence interval [CI], 0.53 to 1.29; men: RR, 1.02; 95% Cl, 0.79 to 1.31) or total CHD (women: RR, 1.01; 95% Cl, 0.76 to 1.34; men: RR, 0.98; 95% Cl, 0.82 to 1.18). When considered separately, there was also no increase in risk of MI or angina. CONCLUSION: These prospective data suggest that migraine is not associated with increased risk of subsequent CHD events in women or men.     

The possible role of infections in acute myocardial infarction.

Cardiovascular diseases, particularly coronary heart disease (CHD) and myocardial infarction (MI), are among the leading causes for morbidity and mortality in industrialized countries [2, 77]. During the past decades, various clinical or lifestyle risk factors for myocardial infarction such as hyperlipidemia, hypertension, obesity, lack of physical exercise and smoking have been identified. However, it is also recognized that these well-documented risk factors do not sufficiently account for all new cases of myocardial infarction [77]. Many patients with myocardial infarction have only a borderline risk profile or even lack known risk factors. The question arises: What additional risk factors may play a role in the etiology of atherosclerosis and ischemic heart disease?     

Gender differences in acute coronary events.

The most frequent cause of death among women in the United States is coronary heart disease, which claims 200,000 lives a year. The prognosis with either medical or surgical therapy is worse in females than in males. The following significant gender differences have been observed and reported: (1) the rate of early death following acute myocardial infarction is greater in women, (2) the difference between sexes remains whether or not thrombolytic therapy is used, and (3) the hospital mortality rate following coronary angioplasty, atherectomy, or bypass surgery is greater in females. The reasons for these gender differences are not clearly understood. Nevertheless, awareness of the higher morbidity and mortality in women dictates the need for early detection and more aggressive therapy of the risk factors. However, diabetes mellitus and essential hypertension are 2 well-established major risk factors for coronary disease and stroke that are more prevalent in the female gender. These 2 risk factors are cumulative and require more intensive and aggressive therapy to prevent acute vascular events, and therefore early detection is mandatory.     

Issues in minority health: atherosclerosis and coronary heart disease in African Americans

Cardiovascular disease (in particular, CHD) is the leading cause of death in the United States for Americans of both sexes and of all racial and ethnic backgrounds. African Americans have the highest overall CHD mortality rate and the highest out-of-hospital coronary death rate of any ethnic group in the United States, particularly at younger ages. Contributors to the earlier onset of CHD and excess CHD deaths among African Americans include a high prevalence of coronary risk factors, patient delays in seeking medical care, and disparities in health care. The clinical spectrum of acute and chronic CHD in African Americans is the same as in whites; however, African Americans have a higher risk of sudden cardiac death and present clinically more often with unstable angina and non-ST-segment elevation myocardial infarction than whites. Although generally not difficult, the accurate diagnosis and risk assessment for CHD in African Americans may at times present special challenges. The high prevalence of hypertension and type 2 diabetes mellitus may contribute to discordance between symptomatology and the severity of coronary artery disease, and some noninvasive tests appear to have a lower predictive value for disease. The high prevalence of modifiable risk factors provides great opportunities for the prevention of CHD in African Americans. Patients at high risk should be targeted for intensive risk reduction measures, early recognition/diagnosis of ischemic syndromes, and appropriate referral for coronary interventions and cardiac surgical procedures. African Americans who have ACSs receive less aggressive treatment than their white counterparts but they should not. Use of evidence-based therapies for management of patients who have ACSs and better understanding of various available treatment strategies are of utmost importance. Reducing and ultimately eliminating disparities in cardiovascular care and outcomes require comprehensive programs of education and advocacy(Box 4) with the goals of (1) increasing provider and public awareness of the disparities in treatment; (2) decreasing patient delays in seeking medical care for acute myocardial infarction and other cardiac disorders; (3) more timely and appropriate therapy for ACSs; (4) improved access to preventive, diagnostic, and interventional cardiovascular therapies; (5) more effective implementation of evidence-based treatment guidelines; and (6) improved physician-patient communications.     

Women's perceptions of coronary heart disease: an integrative review

Coronary heart disease (CHD) is the leading cause of death in American women and is a major cause of morbidity. The American Heart Association (AHA) reports that in the year 2000, 515,661 women died from all categories of cardiovascular disease. An estimated 254,630 women suffer a myocardial infarction annually. Women diagnosed with CHD experienced greater morbidity and mortality than men. Women's perceptions of their risk for heart disease can greatly influence their decision-making process in regard to healthcare decisions. The general public still perceives heart disease as primarily a health problem for men. Evidence shows that women perceive breast cancer as a greater risk than CHD. These misperceptions may lead women to underestimate their risk for CHD and fail to seek early interventions to prevent unnecessary morbidity and mortality. The purpose of this article is to report the results of an integrative review of nursing research related to women's perceptions of risks for heart disease. CINAHL, Medline, EBSCO host, and Proquest databases were searched for nursing research conducted between the years of 1985 and 2002. Key search terms were women, heart disease, coronary artery disease, perceptions, risk factors, and health promotion behaviors. Study selection was limited to the first author being a nurse researcher. Twenty articles and dissertations were retrieved that met the key search terms. Eleven articles were excluded because the first author was not a nurse researcher. This integrative review includes 5 articles and 4 dissertations. Results revealed that women's perceptions of their CHD risks are underestimated, that health-promoting behaviors are not influenced by risk perceptions, that society imposes barriers that prevent participation in health promotion behavior, and that communication between women and their healthcare providers is lacking.     

Coronary heart disease in women and the role of the laboratory.

Coronary heart disease (CHD), the single greatest cause of death in women, is often unrecognized by health care providers and individuals suffering from the disease. CHD is a process in which atherosclerotic lesions composed of lipoprotein particles, macrophages, leukocytes, and smooth muscle cells narrow the lumen of coronary arteries. Two clinical conditions may develop, acute myocardial infarction (AMI) and unstable angina. Signs and symptoms of CHD in women may differ from those of men, leading to delays in treatment and diagnosis. Several well-recognized risk factors for CHD have been identified, including aging, hypertension, hyperlipidemia, diabetes, smoking, obesity, and sedentary lifestyle. The role of the laboratory in CHD involves diagnosing and monitoring persons at risk for developing CHD, diagnosing AMI, monitoring effectiveness of perfusion post AMI, and patient risk stratification.     

超敏C-反应蛋白与血脂联合评估冠心病危险性

目的 探讨超敏C-反应蛋白与血脂联合评估冠心病危险性的临床应用价值。方法 对375名健康体检者、397名冠脉造影阳性组患者和23名心肌梗死组患者的血脂和hsCRP值进行分析。计算危险系数。并对健康组、冠心病组及两性间的危险系数进行统计学分析和评估。结果 不同年龄组（除30-39岁和40-49岁组外）血脂、hsCRP和危险系数均有显著差异，冠脉造影阳性患者的危险系数显著高于健康对照组。但冠脉造影阳性组间危险系数无显著差异。结论 危险系数与动脉粥样硬化的程度无关。健康男女间的危险系数无显著性差异。危险系数评估标准整合了引起动脉粥样硬化的内因-血浆脂蛋白和外在表现-hsCRP两方面的实验数据。反映动脉粥样硬化的临床变化及发生冠心病的实际危险性,消除了冠心病发病危险性评估的性别差异,利于临床的应用。     

Women, coronary heart disease, and dyslipidemia: does gender alter detection, evaluation, or therapy?

Gender-based differences in the prevalence, presentation, and treatment of coronary heart disease (CHD) defines an important area of controversy and research. Gender-based differences include age at onset of CHD, typical presentation of CHD symptoms, relative importance of coronary risk factors, and the potential relationship of ovarian function and estrogen status to the development of CHD. The American Heart Association reported in 1998 that the leading cause of death for American women is cardiovascular disease, with CHD responsible for the majority of total deaths. This article discusses the implication of elevated blood lipids in women. Special emphasis is placed on the role of hormone replacement therapy, an issue unique to women.     

中国与澳大利亚老年冠心病患者左冠状动脉病变特点的对比研究

目的探讨中国南京和澳大利亚悉尼地区的老年冠心病患者左冠状动脉病变是否存在种族和性别差异。方法经冠状动脉造影确诊的冠心病患者,年龄≥60岁,中国南京地区黄种人入选1442例(男性72.0%)为中国组,澳大利亚悉尼当地白种人同期入选1309例(男性65.6%)为澳大利亚组。从左冠状动脉病变率和Gensini积分,左前降支(LAD)和左回旋支(LCX)各段及主要分支病变率及狭窄程度进行比较。结果2组男性患者左冠状动脉病变率显著高于同组女性(P<0.05),但2组患者左冠状动脉的Gensini积分无显著的性别差异(P>0.05)。中国组LAD和LCX近中段的病变率以及LAD和LCX各段及分支(除LCX远段外)的狭窄程度均显著高于澳大利亚组(P<0.001)。结论中国组与澳大利亚组在冠心病危险因素、左冠状动脉病变的分布、狭窄程度和Gensini积分方面存在种族差异。中国组较澳大利亚组具有更严重的左冠状动脉病变,而且没有明显的性别差异。     

Coronary artery disease in women

Cardiovascular disease is the number one cause of death in American women over age 40. Following menopause, the risk for coronary artery disease (CAD) in women is the same as for men. In addition, the major factors that place men at risk are the same for women. However, differences exist in the presentation of symptoms, the ease of diagnosis of CAD, and the morbidity and mortality rates following myocardial infarction (MI), coronary artery bypass surgery, and angioplasty. Because of role differences in men and women, more attention must be paid to developing successful health-promoting and life-style-change strategies in women of all ages.     

Gender difference in the impact of type 2 diabetes on coronary heart disease risk

OBJECTIVE: To explain the stronger effect of type 2 diabetes on the risk of coronary heart disease (CHD) in women compared with men. RESEARCH DESIGN AND METHODS: The study population consisted of 1,296 nondiabetic subjects and 835 type 2 diabetic subjects aged 45-64 years without cardiovascular disease. The end points were CHD death and a major CHD event (CHD death or nonfatal myocardial infarction). The follow-up time was 13 years. RESULTS: Major CHD event rate per 1,000 person-years was 11.6 in nondiabetic men, 1.8 in nondiabetic women, 36.3 in diabetic men, and 31.6 in diabetic women. The diabetes-related hazard ratio for a major CHD event from the Cox model, adjusted for age and area of residence, was 2.9 (95% CI 2.2-3.9) in men and 14.4 (8.4-24.5) in women, and after further adjustment for cardiovascular risk factors, 2.8 (2.0-3.7) and 9.5 (5.5-16.9), respectively. The burden of conventional risk factors in the presence of diabetes was greater in women than in men at baseline. Prospectively, elevated blood pressure, low HDL cholesterol, and high triglycerides contributed to diabetes-related CHD risk more in women than in men. However, after adjusting for conventional risk factors, a substantial proportion of diabetes-related CHD risk remained unexplained in both genders. CONCLUSIONS: The stronger effect of type 2 diabetes on the risk of CHD in women compared with men was in part explained by a heavier risk factor burden and a greater effect of blood pressure and atherogenic dyslipidemia in diabetic women.     

女性早发冠心病病变程度影响因素分析

目的 分析女性早发冠心病冠脉病变严重程度与冠心病危险因素的关系.方法 纳入2017年1月至2020年4月经冠状动脉造影明确冠心病诊断的年龄<65岁的女性患者212例.对患者的冠脉病变进行Gensini评分,根据Gensini评分,将患者分为轻度病变组(n=67)、中度病变组(n=70)和重度病变组(n=75).对各组间...     

老年女性冠心病的危险因素及冠状动脉病变特点

目的探讨老年女性冠心病的危险因素及冠状动脉病变的特点。方法选择冠状动脉造影术的老年女性282例（≥65岁）,分为冠心病组（n=202）和非冠心病组（n=80）,详细记录病史、体检资料,检验尿酸、雌激素、孕激素及雄激素的含量,并记录冠状动脉造影结果。结果与非冠心病组比较,冠心病组闭经年龄较早,糖尿病、高脂血症、高血压所占比例高,尿酸水平明显升高（P〈0.01）,雌二醇水平明显降低（P〈0.01）,两组间孕激素及雄激素水平差异无统计学意义（P〉0.05）;Logistic回归分析显示,尿酸水平与冠心病呈正相关,雌激素水平与冠心病呈负相关;冠心病组中受累血管支数、血管狭窄程度与危险因素数目显示有相关性（P〈0.05）。结论老年女性冠心病与糖尿病、高血压及高脂血症有关,血清雌激素降低及尿酸升高是老年女性冠心病发病的独立危险因素,冠状动脉病变严重程度与危险因素的多少有关。     

高脂血症和冠心病

预防和治疗冠心病仍是目前医疗实践中的一个重点。在冠心病的众多发病因素中,高脂血症与其关系最为密切。大量动物实验和流行病学调查都已证实高脂血症,特别是高胆固醇血症与冠心病的发病率及死亡率有明显的正相关关系, 而通过饮食控制和采用他汀类降脂药物进行治疗、在冠心病的一级或二级预防中降低血浆胆固醇和低密度脂蛋白都可使冠心病的发病率及死亡率明显下降,且使冠状动脉粥样斑块稳定或消退。理解高脂血症与冠心病之间的关系,对于更有效地预防和治疗冠心病是非常重要的