Alcohol intake and mortality in middle aged men with diagnosed coronary heart disease

OBJECTIVE—To examine the effects of alcohol on risk of mortality from coronary heart disease (CHD), cardiovascular disease, and all causes in men with established CHD.
METHODS AND RESULTS—In a population based prospective study of 7169 men aged 45-64 years followed for a mean of 12.8 years, 655 men (9.1%) had a physician diagnosis of CHD (myocardial infarction 455, angina only 200). In these 655 men, there were 294 deaths from all causes including 175 CHD deaths. Ex-drinkers had the highest risk of CHD, cardiovascular mortality, and all cause mortality even after adjustment for lifestyle characteristics and pre-existing disease. Using occasional drinkers as the reference group, lifelong teetotallers, occasional drinkers, and light drinkers all showed similar risks of mortality from CHD, cardiovascular disease, and all causes. Moderate/heavy drinkers showed increased risk of mortality from CHD, cardiovascular disease, and all causes compared to occasional drinkers. The adverse effect of moderate/heavy drinking was confined to the 455 men with previous myocardial infarction (adjusted relative risk for all cause mortality 1.50, 95% confidence interval 1.01 to 2.23). In contrast to lighter drinking, giving up smoking within five years of the start of follow up was associated with a considerable reduction in risk of all cause and cardiovascular mortality compared to those who continued to smoke.
CONCLUSION—Compared to occasional drinking, regular light alcohol consumption (1-14 units per week) in men with established coronary heart disease is not associated with any significant benefit or deleterious effect for CHD, cardiovascular disease or all cause mortality. Higher levels of intake ( 3 drinks per day) are associated with increased mortality in men with previous myocardial infarction. In contrast, smoking cessation in men with established CHD substantially reduces the risk of mortality.


Keywords: coronary heart disease; alcohol consumption; mortality risk; smoking cessation     

Short stature and coronary heart disease: a 35-year follow-up of the Finnish cohorts of The Seven Countries Study

OBJECTIVES: To examine whether short stature is associated with an increased risk of coronary heart disease. DESIGN: Follow-up study. SETTING: Two geographically defined areas in eastern and western Finland. SUBJECTS: A total of 1441 men who were free of coronary heart disease at the start of the follow-up. MAIN OUTCOME MEASURES: Hazard ratios for fatal and non-fatal coronary heart disease RESULTS: Height was inversely related to fatal coronary heart disease and incident non-fatal coronary heart disease during the follow-up. These relationships persisted after adjusting for other major cardiovascular risk factors. Comparing the high-risk area in eastern Finland with the low-risk area in south-western Finland, no difference in fatal coronary heart disease and cumulative incidence of non-fatal coronary heart disease was seen in tall men. The increase in risk of coronary heart disease death was 19% for a 10 cm decrease in height (OR = 0.81, 95% CI = 0.68-0.95). CONCLUSIONS: Our results show that short stature is an independent risk factor for coronary heart disease. Differences in stature partly explain the Finnish east-west difference in the incidence of coronary heart disease.     

Mortality and morbidity from coronary heart disease attributable to passive smoking.

AIMS: Passive smoking is associated with increased risk of coronary heart disease (CHD). This study estimates CHD mortality and morbidity attributable to passive smoking in Germany and demonstrates variations in the number of estimated deaths depending on underlying assumptions. METHODS AND RESULTS: Prevalence of passive smoking from the German National Health Survey, CHD deaths from national mortality statistics, number of incident CHD cases, and relative risks from meta-analyses were used to estimate mortality and morbidity from passive smoking applying the concept of population attributable risk. Sensitivity analyses were carried out to investigate the impact of different assumptions in terms of exposure definition, relative risk, and population at risk on estimated mortality. Exposure to environmental tobacco smoke (ETS) at home accounts for 2148 [approximate 95% confidence interval (CI) 1471-2736] deaths from CHD and 3776 (95% CI 2588-4800) incident CHD cases among non-smokers every year in Germany. In sensitivity analyses, consideration of exposure to ETS at work and at any location yielded 2597 (95% CI 1784-3295) and 8970 (95% CI 6252-11 243) attributable CHD deaths, respectively. Applying different populations at risk showed a range of 1174 (95% CI 803-1494) to 13 792 (95% CI 9655-17 225) attributable deaths from CHD. CONCLUSION: The estimated burden of passive smoking heavily depends on the definition of underlying parameters. Using an evidence-based approach reveals a substantial burden of passive smoking in terms of CHD mortality and morbidity reflected by six CHD deaths and 10 incident CHD cases every day in Germany.     

Coronary heart disease, cancer and mortality in male middle-aged light smokers.

We examined the effect of light smoking in relation to incidence of coronary heart disease (CHD) in a general population sample consisting of 6879 men aged 47-55 years and free of previous myocardial infarction (MI) at baseline. After a follow-up of mean duration 11.8 years, 11.0% of men smoking 1-4 cigarettes daily (n = 228) had suffered a major CHD event, compared to 3.7% of non-smokers (n = 2049) [adjusted odds ratio 2.8 (1.7-4.7)]. No further increase in risk was observed in men who smoked more. There was an increasing risk of death from cancer with the number of cigarettes smoked per day. Mortality was increased in all categories of cigarette smokers, particularly among the very heavy smokers, who had a mortality risk of 22% compared to 6% among nonsmokers [adjusted odds ratio 4.4 (2.7-7.1)]. Data from an examination 4 years later considered only those men who stated that their smoking habits were identical on both occasions (n = 3981). Among these subjects the incidence of CHD after a mean period of 7.1 years was 10.6% in men smoking 1-4 cigarettes per day, compared to 2.6% in nonsmokers [adjusted O.R. 4.6 (2.1-10.1)]. No dose-response effect was observed. Even very light cigarette smoking considerably increases the risk of CHD in middle-aged men.     

Risk factors for coronary heart disease in 55- and 35-year-old men and women in Sweden and Estonia

OBJECTIVE: To illustrate the geographical West-to-East division of coronary heart disease (CHD) by comparing a population from Sweden, that represents a Western country to a population from Estonia, that represents an Eastern country. Estonia has an approximately 2-4-fold higher CHD prevalence for 55-year-old women and men, respectively, than Sweden. DESIGN: Randomized screening of 35- and 55-year-old men and women in Sollentuna county, Sweden and Tartu county, Estonia. Eight hundred subjects, 100 from each cohort, were invited to participate in the study, 272 Swedes and 277 Estonians participated. SETTING: Preventive cardiology, administered by a primary health care centre at the Karolinska Hospital, Sweden and a cardiology centre at Tartu University Hospital, Estonia. MAIN OUTCOME MEASURES: The CHD risk factors (smoking, blood pressure, concentrations of lipoproteins, fibrinogen, and glucose) and certain environmental factors and attitudes related to CHD risk by questionnaires (fat-type and alcohol ingestion, self-assessed rating of CHD susceptibility). RESULTS: Of the 55-year-old men, 57% smoked in Estonia and 20% smoked in Sweden. Similar, although less pronounced differences showing higher smoking prevalence, were seen for 35-year-old Estonian men and women, whilst for 55-year-old women, less than 20% smoked in either country. Estonian 55-year-old women had lower HDL cholesterol and higher LDL cholesterol serum concentrations than Swedish 55-year-old women. Estonians reportedly ate food containing more saturated fats than Swedes, as indicated by the scale-score questionnaire. Estonians, relative to Swedes, rated their chance of developing CHD higher, and paradoxically, Estonians did to a much lesser degree believe that life style influences the risk of developing CHD. CONCLUSIONS: Elevated smoking prevalence is a striking difference between the Estonian and Swedish populations likely to explain the much higher CHD prevalence in Estonian men. The lower HDL cholesterol and higher LDL cholesterol in Estonian 55-year-old women may explain the higher CHD prevalence in Estonian women. Furthermore, the SWESTONIA CHD study (i.e. comparison between Sweden and Estonia) shows several environmental differences between the countries populations related to fat content in food, alcohol drinking patterns, and views on CHD risk and the importance of lifestyle intervention, that could contribute to the higher CHD prevalence in Estonia.     

Fibrinogen as a risk factor for coronary heart disease and mortality in middle-aged men and women: The Scottish Heart Health Study

Aims Fibrinogen was measured in 5095 men and 4860 men aged 40–59in a random population sample from 25 districts of Scotlandrecruited during 1984–87: the Scottish Heart Health Study.Fibrinogen was then related to the chance of fatal and non-fatalcoronary events and death from any cause during a subsequentfollow-up period of around 8 years. Methods and results Fibrinogen was measured by the Clauss assay.The effect of fibrinogen on coronary heart disease and deathwas assessed through age-adjusted means and Cox proportionalhazards regression models, accounting for age, cotinine (a measureof tobacco smoke inhalation) and 11 other major coronary riskfactors. Fibrinogen was found to be an important risk factorfor coronary heart disease in men and women, with and withoutpre-existing coronary heart disease. There appears to be a thresholdeffect, with those in the highest fifth of the distributionhaving a much increased risk. Estimated age- adjusted hazardratios by sex and pre-existing coronary heart disease groupfor the highest to lowest fifth of fibrinogen range between1·93 and 4·86. Fibrinogen is also important asa risk factor for coronary death and all-causes mortality, witha similar threshold effect. Comparing the two extreme fifths,the hazard ratios for coronary death are 3·01 and 3·42,and for all-cause mortality are 2·59 and 2·20,for men and women respectively. Adjustment for cotinine reducesthe hazard ratios, but further adjustment for the other 11 riskfactors has little effect for coronary heart disease events.After full adjustment there is a remaining significant (P<0·05)hazard ratio for coronary death and death from any cause andfor a coronary heart disease event for those free of coronaryheart disease at baseline, amongst men, comparing the highestto the lowest fifth. Conclusion Fibrinogen is a strong predictor of coronary heartdisease, fatal or non-fatal, new or recurrent, and of deathfrom an unspecified cause, for both men and women. Its effectis only partially attributable to other coronary risk factors,the most important of which is smoking.     

Alcohol and coronary heart disease: the roles of HDL-cholesterol and smoking

Objectives. To study the role of HDL-cholesterol (HDLc) in the causal pathway mediating the effect of alcohol on coronary heart disease (CHD).
Design. Cox proportional hazard models were used to compare the relative CHD risks in various HDLc–smoking categories.
Setting. A prospective, multicentre, placebo-controlled, double-blind CHD primary prevention trial with gemfibrozil in primary (occupational) health care units, the Helsinki Heart Study.
Subjects. Dyslipidaemic middle-aged men with available alcohol consumption data (1924 of 2035) in the placebo arm of the 5-year study.
Main outcome measures. Seventy-seven (of 84) cases of nonfatal myocardial infarction or cardiac death.
Results. A U-shaped association was detected between alcohol consumption and CHD. The protection was found both in subjects with low (mean 0.94 mmol L⁻¹) and normal (mean 1.25 mmol L⁻¹) HDLc with corresponding reductions of 23% and 36% in relative risks. In contrast to previous data, alcohol offered virtually no protection against CHD in non-smokers. In subjects consuming more than 800 g pure ethanol annually, the CHD incidence was 6/1000 in subjects with more than three weekly drinking occasions, compared to 11/1000 in 'weekend' drinkers.
Conclusions. Our results confirm the protective effect of alcohol against CHD. However, in contrast to previous data the effect in our population is restricted to smokers and the role of HDLc in mediating the effect is less central than suggested previously.     

Leisure-time physical activity is inversely related to risk factors for coronary heart disease in middle-aged Finnish men

Coronary risk factors and levels of physical activity at leisurewere measured in a random sample of 3975 men 25–64 yearsof age residing in four areas of Finland. An index of leisure-timephysical activity (LTPA) as the product of weekly exercise sessionstimes their usual intensity (expressed as metabolic equivalents)was computed. It showed a graded, inverse association with meanarterial blood pressure, smoking and serum thiocyanate, coronaryheart disease risk estimate (combining blood pressure, totalcholesterol and smoking), and a nonlinear favorable associationwith serum lipoproteins. In multiple regression analysis, LTPAcontributed significantly and independently to the variationin mean arterial pressure; the standardized regression coefficientswere –0.06 for LTPA, 0.09 for weekly alcohol consumption,0.25 for body mass index, 0.25 age. In the regression of coronaryrisk estimate, the standardized regression coefficients were–0.19 for LTPA, 0.22 for weekly alcohol consumption, 0.09for body mass index, 0.15 for age. There was no evidence thatLTPA above 2000 kcal of weekly energy expenditure was associatedwith further reduced coronary risk factor levels. These findingsthus support the inverse direction of the association betweenexercise and coronary risk factors but they also point towardsan independent, but modest, role of leisure-time physical activityas determinant of coronary risk estimate and blood pressure     

Leisure-time physical activity is inversely related to risk factors for coronary heart disease in middle-aged Finnish men

Coronary risk factors and levels of physical activity at leisurewere measured in a random sample of 3975 men 25–64 yearsof age residing in four areas of Finland. An index of leisure-timephysical activity (LTPA) as the product of weekly exercise sessionstimes their usual intensity (expressed as metabolic equivalents)was computed. It showed a graded, inverse association with meanarterial blood pressure, smoking and serum thiocyanate, coronaryheart disease risk estimate (combining blood pressure, totalcholesterol and smoking), and a nonlinear favorable associationwith serum lipoproteins. In multiple regression analysis, LTPAcontributed significantly and independently to the variationin mean arterial pressure; the standardized regression coefficientswere –0.06 for LTPA, 0.09 for weekly alcohol consumption,0.25 for body mass index, 0.25 age. In the regression of coronaryrisk estimate, the standardized regression coefficients were–0.19 for LTPA, 0.22 for weekly alcohol consumption, 0.09for body mass index, 0.15 for age. There was no evidence thatLTPA above 2000 kcal of weekly energy expenditure was associatedwith further reduced coronary risk factor levels. These findingsthus support the inverse direction of the association betweenexercise and coronary risk factors but they also point towardsan independent, but modest, role of leisure-time physical activityas determinant of coronary risk estimate and blood pressure     

Fibrinogen, coronary heart disease and mortality from all causes in smokers and nonsmokers. The Study of Men Born in 1933

Objective. To analyse the relation between fibrinogen concentration and incidence of coronary heart disease and mortality from all causes. A secondary aim was to investigate whether the effect of fibrinogen, as in previous cross-sectional analyses from this population, was restricted to nonsmokers. Design. Prospective population study. Setting. City of Göteborg, Sweden. Subjects. A total of 664 men from a population sample of 1016 men aged 50 in 1983, without prior myocardial infarction. Main outcome measures. Development of coronary heart disease (myocardial infarction, coronary death or, in men with angina, revascularization, or scintigraphic evidence of coronary disease) and death from all causes, in relation to fibrinogen concentration and smoking status at baseline, during 9 years' follow-up. Results. Rates of coronary heart disease during follow-up in the lowest, middle and highest third of the fibrinogen distribution were 4.6, 6.4 and 10.3%, respectively, but this did not remain significant after controlling for smoking and other risk factors (adjusted odds ratio [OR] for the highest, compared to the lowest third 1.5 [0.7–3.4]). Percentages of men who died from any cause were 3.2, 5.9 and 10.7 in the lowest, middle and highest thirds of fibrinogen, respectively. After adjustment for smoking and other risk factors, this difference remained significant (relative risk 2.6 [1.2–5.9]). In men who were smokers at baseline, fibrinogen was not significantly related to coronary heart disease or mortality. Men who did not smoke in the lowest, middle, and highest third of the fibrinogen distribution had rates of coronary heart disease of 1.8, 3.6 and 10.3%, respectively, and of deaths from all causes of 1.8, 2.9 and 8.4%, respectively. The adjusted OR remained significant at 5.4 (1.4–20.0) for coronary heart disease, as did the adjusted relative risk for mortality at 3.8 (1.01–14.4). Conclusion. Plasma fibrinogen is an independent predictor of premature death, and also of coronary heart disease, in middle-aged men and in nonsmokers. A high fibrinogen concentration, particularly in a nonsmoker, deserves attention.     

吸烟的冠心病患者戒烟现状及影响因素分析

目的 了解吸烟的冠心病患者对于吸烟问题的认识及戒烟状况,揭示戒烟及戒烟未成功的原因和影响因素,为更有效地帮助冠心病患者控烟提供参考.方法 对350例吸烟的冠心病患者进行问卷调查,包括性别、年龄、吸烟史等,采用分组分析、logistic回归分析等方法分析戒烟的影响因素.结果 350例吸烟的冠心病患者平均年龄(59.6±10.2)岁,男321例(占91.7%).57.1%(200/350)的患者已戒烟,42.9%(150/350)的患者目前仍在吸烟.将患者按年龄分两组,非老年组患者(≤65岁,n=239)戒烟率50.6%,显著低于老年组患者(>65岁,n=111)的71.2%(P<0.001).非老年组有戒烟意愿及尝试过戒烟的比例分别为70.3%和48.3%,均低于老年组的81.2%和59.4%(P<0.001).76例戒烟复吸者中,复吸最主要原因为缺乏自我控制能力,占76.3%.logistic回归分析,影响戒烟未成功的因素:年龄≤65岁(OR=2.336,P=0.004)、文化程度低(OR=1.310,P=0.028)、行经皮冠状动脉介入治疗术(OR=0.261,P<0.001)、行冠状动脉旁路移植术(OR=0.107,P=0.004)、家庭总收入>4000 元/月(OR=1.828,P=0.003).结论 吸烟的冠心病患者戒烟水平和意识仍有待提高;除现有的控烟政策外,应更加关注中青年、文化程度较低、未行经皮冠状动脉介入治疗及冠状动脉旁路移植术、家人有人吸烟、体质指数及家庭总收入越高的吸烟冠心病患者的控烟活动;在针对吸烟冠心病患者控烟活动的同时对其周围环境宣传控烟活动也是迫切需要的.

Abstract：

Objective To investigate the status quo of smoking cessation and analyze factors influencing smoking cessation in cigarette smoking patients with coronary artery disease(CAD).Method A total of 350 smoking patients with CAD was surveyed by questionnaire,logistic regression analysis was performed to analyze factors influencing smoking cessation.Results Incidence of smoking cessation was 57.1%(200/350)in this cohort.Patients were divided into two groups,the elderlv(>65 years old,n=111)and the young group(≤65 years old,n=239).The smoking cessation rate in the elderlv group is significantly higher than in the young group(71.2%vs.50.6%,P<0.001).Aged patients and patients with high cultural level are easier to give up smoking.Logistic analysis showed that age≤65 years old (OR=2.336,P=0.004),low cultural level(OR=1.310,P=0.028),PCI(OR=0.261.P<0.001).coronary artery bypass graft(OR=0.107,P=0.004),total family income>4000 RMB/month (OR=1.828,P=0.003)are risk factors for failed smoking cessation.There are 76 patients smoking again in current smokers,most due to lack of self-control(76.3%).Compared to the elderly group,there is a higher proportion of smoking again due to the need of daily communication and work in the young group.Conclusions We still need to raise the awareness of smoking cessation for smoking patients with CAD.Following factors should be focused for tobacco control in CAD patients:younger age,lower cuItural level,not treated with PCI or CABG,patients with smoking family members.higher body mass index and higher total family income.     

PR Interval in middle-aged men with overt and latent coronary heart disease compared to PR in angionegative and normal men of similar age

Summary: PR was measured prospectively in 2014 apparently healthy men ranging in age from 40 to 59 years (P subjects), and retrospectively in 652 hospitalized men with a diagnosis of coronary heart disease (CHD) (R subjects). A cardiovascular survey examination suggested CHD in 115 of the 2014 P subjects, coronary angiography of 105 of these confirmed this suspicion in 69. The following observations concerning PR were made: (1) the shortest PR was found in angiopositive P subjects, intermediate PR in 1832 normal P subjects, and PR was longest in 36 angionegative subjects. (2) PR was shortest in angiopositive P subjects with triple-vessel disease, and longest in P subjects with single-vessel disease. (3) PR increased with age, and an inverse association was found between PR and resting heart rate in P-subjects. (4) In 98 of 1832 normal P subjects, all without signs or symptoms of heart disease, PR was ±0.22 s. (5) Prolonged PR was no more frequent among the 652 R subjects than among P subjects, despite significant CHD in 595, and a frequent use of drugs known to delay atrioventricular conduction. It is suggested that advanced stable clinical CHD only rarely gives rise to prolonged PR at rest, and that PR in subjects with latent CHD may have somewhat shorter PR than age counterparts without symptoms or signs of CHD. Conflicting data in the literature are probably related to differences in material and methods.     

The association of alcohol consumption with coronary heart disease mortality and cancer incidence varies by smoking history

OBJECTIVE: To evaluate the effect of alcohol on coronary heart disease (CHD), cancer incidence, and cancer mortality by smoking history. DESIGN/SETTING: A prospective, general community cohort was established with a baseline mailed questionnaire completed in 1986. Participants: A population-based sample of 41,836 Iowa women aged 55-69 years. MEASUREMENTS: Mortality (total, cancer, and CHD) and cancer incidence outcomes were collected through 1999. Relative hazard rates (HR) were calculated using Cox regression analyses. MAIN RESULTS: Among never smokers, alcohol consumption (> or =14 g/day vs none) was inversely associated with age-adjusted CHD mortality (HR, 0.40; 95% confidence interval [CI], 0.19 to 0.84) and total mortality (HR, 0.71; 95% CI, 0.55 to 0.92). Among former smokers, alcohol consumption was also inversely associated with CHD mortality (HR, 0.45; 95% CI, 0.23 to 0.88) and total mortality (HR, 0.78; 95% CI, 0.62 to 0.97), but was positively associated with cancer incidence (HR, 1.25; 95% CI, 1.03 to 1.51). Among current smokers, alcohol consumption was not associated with CHD mortality (HR, 1.05; 95% CI, 0.73 to 1.50) or total mortality (HR, 1.07; 95% CI, 0.92 to 1.25), but was positively associated with cancer incidence (HR, 1.30; 95% CI, 1.10 to 1.54). CONCLUSIONS: Health behavior counseling regarding alcohol consumption for cardioprotection should include a discussion of the lack of a decreased risk of CHD mortality for current smokers and the increased cancer risk among former and current smokers.     

Sleep complaints predict coronary artery disease mortality in males: a 12-year follow-up study of a middle-aged Swedish population

OBJECTIVES: Only a few prospective surveys have been performed to investigate the relationship between sleep complaints and coronary artery disease (CAD) mortality. This study was conducted to determine whether sleep complaints in a middle-aged population predicted total mortality and CAD mortality. DESIGN: A population-based prospective study. Setting. The County of Dalarna, Sweden. SUBJECTS AND METHODS: In 1983, a random sample of 1870 subjects aged 45-65 years responded to a postal questionnaire (response rate 70.2%) including questions about sleep complaints and various diseases. Mortality data for the period 1983-95 were collected, and Cox proportional hazard analyses were used to examine the mortality risks. RESULTS: At 12-year follow-up 165 males (18.2%) and 101 females (10.5%) had died. After adjustment for a wide range of important putative risk factors, difficulties initiating sleep (DIS) were related to CAD death in males [relative risk (RR), 3.1; 95% confidence interval (CI), 1.5-6.3; P < 0.01], but not in females. Short or long sleep duration did not influence risk of CAD mortality or total mortality for either gender. Depression in males increased the risk of death attributed to CAD (RR, 3.0; 95% CI, 1.1-8.4; P < 0.05) and total mortality (RR, 2.2; 95% CI, 1.1-4.5; P < 0.05). CONCLUSION: These results provide evidence that there is an association between difficulties falling asleep and CAD mortality in males.     

青年吸烟冠心病患者冠状动脉病变特点和控烟干预

目的 分析青年吸烟冠心病患者冠状动脉病变特点,并探讨人为干预对控烟的影响.方法 入选确诊为冠心病的青年患者160例(14～35岁),将吸烟患者118例和非吸烟患者42例均分为心理辅导组和对照组.通过冠状动脉造影分析患者的冠状动脉病变特点,并调查出院后3个月患者的吸烟情况.结果 与非吸烟患者比较,吸烟患者单支病变的比例较低(50.84%比66.67%,P＜0.01),急性冠状动脉综合征(75.42%比50.00%,P＜0.05)、双支病变(24.58%比19.05%,P＜0.05)、三支病变(11.86%比4.47%,P＜0.05)、冠状动脉瘤样扩张(12.71%比9.52%,P＜0.01)的比例和Gensini积分(61.94±40.35比45.08±28.97,P＜0.05)较高.在3个月的随访期中,吸烟患者心理辅导组的戒烟率高于对照组(61.76%比30.00%,P＜0.05);非吸烟患者心理辅导组的新发吸烟率低于对照组(0比5.00%,P＜0.05).结论 青年吸烟冠心病患者的冠状动脉病变程度重于非吸烟患者.人为干预有助于控烟.     

吸烟致冠状动脉粥样硬化性心脏病机制研究进展

吸烟是促进心血管疾病发生、发展的重要危险因素。在全球,烟草相关疾病每年约引起500万人死亡,其中超过1／3死于心血管疾病。冠状动脉粥样硬化性心脏病（简称冠心病）是与吸烟关系最为密切的心血管疾病之一,吸烟者冠心病发生率可增加2～3倍[2]。研究吸烟与冠心病的关系及致病机制有助于禁烟、戒烟及对心血管疾病的防治。     

Different measures of alcohol consumption and risk of coronary heart disease and all-cause mortality: 11-year follow-up of the Whitehall II Cohort Study

Aims To investigate the relationship between three measures of alcohol consumption obtained simultaneously in a large cohort and the validated risk of coronary heart disease and all‐cause mortality during follow‐up. Design Prospective cohort study with median follow‐up of 11 years. Setting The Whitehall II Cohort Study: London‐based civil service. Participants A total of 10 308 (33% female) civil servants aged 35–55 years at baseline (1985–88). Measurements Self‐reported volume of alcohol consumed during past week, frequency of drinking over past year, usual amount consumed per drinking session. Main outcome measures Coronary heart disease and all‐cause mortality until 1999. Findings A U‐shaped relationship was found between volume of alcohol consumed per week and outcome. Compared to those who drank moderately (10–80 g alcohol per week), non‐drinkers and those drinking more than 248 g per week had approximately a twofold increased risk of mortality. The optimal frequency of drinking was between once or twice a week and daily, after adjustment for average volume consumed per week. Those drinking twice a day or more had an increased risk of mortality (male hazard ratio 2.44 95% CI 1.31–4.52) compared to those drinking once or twice a week. Drinking only once a month or only on special occasions had a 50% increased risk of mortality. The usual amount consumed per drinking session was not indicative of increased health risk in this cohort. Conclusions Epidemiological studies should collect information on frequency of drinking in addition to average volume consumed in order to inform sensible drinking advice.     

Contribution of modern cardiovascular treatment and risk factor changes to the decline in coronary heart disease mortality in Scotland between 1975 and 1994

OBJECTIVE: To estimate the fall in coronary heart disease (CHD) mortality in Scotland attributable to medical and surgical treatments, and risk factor changes, between 1975 and 1994. DESIGN: A cohort model combining effectiveness data from meta-analyses with information on treatment uptake in all patient categories in Scotland. SETTING AND PATIENTS: The whole Scottish population of 5.1 million, including all patients with recognised CHD. INTERVENTIONS: All cardiological, medical, and surgical treatments, and all risk factor changes between 1975 and 1994. Data were obtained from epidemiological surveys, routine National Health Service sources, and local audits. MAIN OUTCOME MEASURES: Deaths from CHD in 1975 and 1994. RESULTS: There were 15 234 deaths from CHD in 1994, 6205 fewer deaths than expected if there had been no decline from 1975 mortality rates. In 1994, the total number of deaths prevented or postponed by all treatments and risk factor reductions was estimated at 6747 (minimum 4790, maximum 10 695). Forty per cent of this benefit was attributed to treatments (initial treatments for acute myocardial infarction 10%, treatments for hypertension 9%, for secondary prevention 8%, for heart failure 8%, aspirin for angina 2%, coronary artery bypass grafting surgery 2%, and angioplasty 0.1%). Fifty one per cent of the reduction in deaths was attributed to measurable risk factor reductions (smoking 36%, cholesterol 6%, secular fall in blood pressure 6%, and changes in deprivation 3%). Other, unquantified factors apparently accounted for the remaining 9%. These proportions remained relatively consistent across a wide range of assumptions and estimates in a sensitivity analysis. CONCLUSIONS: Medical treatments and risk factor changes apparently prevented or postponed about 6750 coronary deaths in Scotland in 1994. Modest gains from individual treatments produced a large cumulative survival benefit. Reductions in major risk factors explained about half the fall in coronary mortality, emphasising the importance and future potential of prevention strategies.     

Registration and management of smoking behaviour in patients with coronary heart disease. The EUROASPIRE survey.

AIMS: To establish to what extent smoking status and its management is recorded in coronary patients' medical records, and to investigate their motivation to change smoking behaviour. METHODS: In EUROASPIRE, a survey on secondary prevention in 21 hospitals in the Czech Republic, Finland, France, Germany, Hungary, Italy, the Netherlands, Slovenia and Spain, data were collected from records of 4863 consecutive patients =<70 years of age, with previous (>6 months) admission for coronary bypass operation, angioplasty, myocardial infarction or ischaemia. Of these, 3569 patients were interviewed 1.6 years following their index hospitalization. RESULTS: Of the 82% of patients whose pre-hospitalization smoking behaviour was known, 34% were smokers. Documentation was significantly better in younger patients, in males and patients requiring angioplasty or bypass operation. In only 35% of 1364 smokers was the smoking habit recorded again after discharge from hospital At the time of the interview, 554 of the interviewed patients were still smoking. In over 90% of the smokers, advice to quit smoking was reported at interview. A positive relationship was found between receiving advice and seeking help to stop smoking, between receiving advice to stop smoking and attempting to stop, as well as between seeking help and attempting to stop. CONCLUSION: In almost 20% of coronary patients, smoking habits are not documented in medical records, and in only 35% of the smoking patients is smoking status documented at the follow-up. After a cardiac event requiring hospitalization as many as 50% of patients continue their smoking habit and so there is further potential to reduce the risk of recurrent coronary disease. Advice to stop smoking motivates patients to seek help and to attempt to stop smoking. Physicians repeated advice to stop smoking is important and smoking status should always be documented at follow-up.     

The Helsinki Heart Study: coronary heart disease incidence during an extended follow-up

Abstract. Objectives . To confirm that coronary heart disease (CHD) can be prevented by gemfibrozil treatment and to estimate the long-term effect of the treatment. Design . All participants of the Helsinki Heart Study, a controlled 5-year CHD primary prevention trial with gemfibrozil and placebo, were offered gemfibrozil treatment and biannual follow-up for 3.5 more years. Setting . By the end of the multi-clinic double-blind trial, a 34% difference in definite cardiac events (56 vs. 84; P < 0.2) had developed between the gemfibrozil and placebo groups. Subjects . There were 2046 dyslipidaemic men in the gemfibrozil group at randomization, 1961 started the extended follow-up; the comparison group comprised 2035 men, and 5 years later 1928 men. Interventions . Gemfibrozil was selected by 66.3% of gemfibrozil and 68.5% of placebo men without previous CHD end-points. Main outcome measures . Definite fatal and non-fatal CHD events are reported, possible CHD events were recorded but reported selectively. Results . During the post-trial period the numbers of definite CHD events in both groups (54 vs. 47; NS) were smaller than expected without treatment, namely a reduction of around 40% for the original treatment groups. The mean incidence rates were in fact similar to that in the placebo group 5 years earlier. The post-trial CHD incidence was lowest amongst the placebo group men who later selected gemfibrozil. Cardiovascular mortality over the entire study period was similar but all-cause mortality was slightly higher amongst men of the original gemfibrozil group compared to the placebo group men (P = 0.19). Conclusions . Thus prolonged gemfibrozil treatment postpones cardiac events. This protective effect presumably involves both attenuation of atherosclerosis and mechanisms related to acute cardiac events.