Type of alcoholic drink and risk of major coronary heart disease events and all-cause mortality

OBJECTIVES: This study examined the effects of beer, spirits, and wine drinking on coronary heart disease (CHD) events (fatal and nonfatal) and all-cause mortality. METHODS: Men aged 40 to 59 years (n = 7735) were drawn at random from one general practice in each of 24 British towns and followed up for an average of 16.8 years. RESULTS: Regular drinkers showed a significantly lower relative risk of CHD, but no all-cause mortality, than occasional drinkers, even after adjustment for potential confounders. The benefit for CHD of regular drinking was seen within both beer drinkers and spirit drinkers but not among men who reported wine drinking. However, all men who reported wine drinking (both occasional and regular) showed significantly lower age-adjusted risks of CHD and all-cause mortality than men drinking beer or spirits; beer and spirit drinkers showed similar risks. CONCLUSIONS: The findings suggest that regular intake of all alcoholic drinks is associated with a lower risk of CHD, but not all-cause mortality, than occasional drinking. A large part, but not all, of the greater benefit seen in wine drinkers relative to other drinkers can be attributed to advantageous lifestyle characteristics (e.g., low rates of smoking and obesity).     

Variability of angina symptoms and the risk of major ischemic heart disease events.

Variability of angina symptoms over a 5-year period was examined in a prospective study, in which 7,109 British middle-aged men completed two chest pain questionnaires, Q1 (1978-1980) and Q5 (1983-1985), and were classified as having no chest pain, nonexertional chest pain, or angina (Q) (exertional chest pain) on each occasion. Within persons, there was considerable variability in response to the chest pain questions at Q1 and Q5. Angina (Q) persistence showed marked associations with previous myocardial infarction, diagnosed angina, electrocardiogram ischemia, and subsequent major ischemic heart disease events from Q5 onward. Compared with men without angina (Q), the age-adjusted hazard ratios were 1.5 (95% confidence interval (CI): 1.1, 2.2) for angina (Q) at Q1 only, 2.6 (95% CI: 2.1, 3.2) for angina (Q) at Q5 only, and 3.4 (95% CI: 2.8, 4.3) for angina (Q) on both occasions. For men without diagnosed ischemic heart disease, for whom apparent remission of angina (Q) was particularly frequent, a similar pattern of association was found between angina (Q) persistence and subsequent major events. In middle-aged men, exertional chest pain is a strong indicator of major coronary risk but frequently appears transient in the longer term. Persistently reported symptoms are associated with severe disease and a poor prognosis.     

Asymptomatic hyperglycaemia and major ischaemic heart disease events in Britain.

OBJECTIVE--To examine the association between non-fasting serum glucose concentrations and major ischaemic heart disease (IHD) events (fatal and non-fatal myocardial infarction). DESIGN--A prospective study. SUBJECTS--A population based sample of 7735 middle aged British men. Known diabetics, men with a glucose concentration > or = 11.1 mmol/l at screening, and hypertensive patients taking regular medication were excluded from the analysis. With exclusions (n = 509) and missing glucose values (n = 49), there were 7177 men available for analysis. MAIN OUTCOME MEASURES--Major IHD events (fatal and non-fatal myocardial infarction) during 9.5 years follow up on all men. RESULTS--There were 505 major IHD events, 222 fatal and 283 non-fatal, in the 7177 men studied. There was a non-linear relation between the glucose concentration and the risk (per 1000 men per year) of all major IHD events and fatal IHD events, with the excess risk in the upper quintile of the glucose distribution (> or = 6.1 mmol/l). The unadjusted relative risks (RR) in the upper glucose concentration quintile compared with the first to the fourth quintiles combined were 1.4 (95% CI 1.1, 1.7) for all events and 1.3 (95% CI 1.0, 1.7) for fatal events. Adjustment for age, smoking, occupational status, body mass index, physical activity, systolic blood pressure, total and high density lipoprotein cholesterol, and triglyceride concentrations had a minimal effect on these relative risk estimates. This non-linear relationship between the serum glucose concentration and the risk of a major IHD event was observed in men with no evidence of IHD at screening (n = 5518) but not in men with IHD (n = 1659). In the former group, the RR (adjusted for major coronary risk factors) for all major IHD events in the upper quintile relative to the lower quintiles combined was 1.5 (95% CI 1.2, 2.0) and for fatal IHD events was 1.8 (95% CI 1.1, 2.6). CONCLUSION--These data suggest that asymptomatic hyperglycaemia is an independent risk factor for major IHD events.     

Prospective study of major dietary patterns and risk of coronary heart disease in men

BACKGROUND: Previous studies on diet and coronary heart disease (CHD) focused primarily on individual nutrients or foods. OBJECTIVE: We examined whether overall dietary patterns derived from a food-frequency questionnaire (FFQ) predict risk of CHD in men. DESIGN: This was a prospective cohort study of 44875 men aged 40-75 y without diagnosed cardiovascular disease or cancer at baseline in 1986. RESULTS: During 8 y of follow-up, we documented 1089 cases of CHD (nonfatal myocardial infarction and fatal CHD). Using factor analysis, we identified 2 major dietary patterns using dietary data collected through a 131-item FFQ. The first factor, which we labeled the "prudent pattern," was characterized by higher intake of vegetables, fruit, legumes, whole grains, fish, and poultry, whereas the second factor, the "Western pattern," was characterized by higher intake of red meat, processed meat, refined grains, sweets and dessert, French fries, and high-fat dairy products. After adjustment for age and CHD risk factors, the relative risks from the lowest to highest quintiles of the prudent pattern score were 1.0, 0. 87, 0.79, 0.75, and 0.70 (95% CI: 0.56, 0.86; P: for trend = 0.0009). In contrast, the relative risks across increasing quintiles of the Western pattern score were 1.0, 1.21, 1.36, 1.40, and 1.64 (95% CI: 1.24, 2.17; P: for trend < 0.0001). These associations persisted in subgroup analyses according to cigarette smoking, body mass index, and parental history of myocardial infarction. CONCLUSIONS: These data suggest that major dietary patterns derived from the FFQ predict risk of CHD, independent of other lifestyle variables.     

Diabetes and coronary heart disease risk in Mexican Americans.

Mexican Americans have a high prevalence of diabetes relative to non-Hispanic whites, but paradoxically experience a lower prevalence of myocardial infarction and lower cardiovascular mortality (at least in men). To determine whether Mexican Americans might be more resistant to the atherogenic effects of diabetes than non-Hispanic whites, we examined the associations between diabetes and myocardial infarction and selected coronary heart disease (CHD) risk factors in these two ethnic groups. The study population consisted of 5149 Mexican Americans and non-Hispanic whites who were 25 to 64 years old and recruited from the San Antonio Heart Study, a population-based study of cardiovascular risk factors and diabetes conducted between 1979 and 1988. Diabetic men were more than twice as likely to have an electrocardiography (ECG)-documented myocardial infarction than were nondiabetic men, while diabetic women were more than three times as likely to have a myocardial infarction than were nondiabetic women. In both sexes the association between myocardial infarction and diabetes was nearly identical between the two ethnic groups. In both ethnic groups diabetes was also more strongly associated with conventional CHD risk factors (e.g., triglycerides, systolic blood pressure, and high-density-lipoprotein cholesterol) in women than in men. Furthermore, these associations were at least as strong, if not stronger, in Mexican Americans as in non-Hispanic whites. Thus, these data provide no evidence to suggest that Mexican Americans are resistant to the lipid-altering effects of diabetes. We conclude that the protective effect against CHD conferred by Mexican American ethnicity may be obscured in part by the high prevalence of diabetes in this ethnic group.     

Lipids and risk of coronary heart disease. The Framingham Study.

Total cholesterol level is significantly related to risk of coronary heart disease (CHD), adjusting for other risk factors in women 50 to 79 years old and in men aged 50 to 64 years, at P < .001. Determining the levels of lipoproteins such as low-density-lipoprotein (LDL) cholesterol and high-density-lipoprotein (HDL) cholesterol improves the prediction of risk. Triglycerides are independently related in women at all ages but miss statistical significance in the multivariate studies in men. The total cholesterol-HDL cholesterol ratio is another powerful predictor at all ages in women and is the only lipid predictor independently related to CHD in men 65 to 80 years old. Inspection of the age-specific association of cholesterol with risk in men and women also reveals that the absolute rates of disease worsen with age.     

Platelet aggregation and coronary heart disease risk factor variation in Australian populations with different coronary heart disease mortality.

In a cross-sectional analytic study, we examined the differences in coronary heart disease (CHD) risk factors, including coagulation factors and platelet aggregation, among males from southern European countries and those of Anglo-Celtic descent who had widely different CHD standardized mortality ratios. The participants included 169 men aged 40 to 49 years, 27% of whom were born in southern European countries. The subjects had no history of heart disease and no other clinical conditions, or were not taking medications known to affect hemostasis. Data obtained included their medical history and CHD-related risk behaviors, blood pressure, height, weight, abdominal and pelvic circumference, and coagulation, fibrinolysis, platelet activity, lipids, and lipoproteins profiles. There were significant differences between the two groups in the prevalence of a positive family history, mean apolipoprotein A1 levels, and platelet aggregation responses to ADP. Other established risk factors, including coagulation factor levels, were not significantly different.     

疾病家族史与冠心病发生风险的关联研究

目的 分析疾病家族史对急性冠心病事件（MCE）及缺血性心脏病（IHD）发病风险的影响。方法 研究对象来自中国慢性病前瞻性研究,剔除基线时患有恶性肿瘤、心脏病及脑卒中的个体,纳入485 784人进行分析。统计分析采用Cox比例风险模型。结果 研究人群随访M=7.2年,随访期间新发MCE 3 934例,IHD 24 537例。与无家族史者相比,有家族史者发生MCE及IHD的风险均较高,HR值（95% CI）分别为1.41（1.19~1.65）和1.25（1.18~1.33）。与双亲型家族史相比,同胞型家族史与早发MCE的关联更强（HR=2.97,95% CI：1.80~4.88）;超重/肥胖者中家族史与MCE、IHD的关联更强;吸烟者中家族史与MCE的关联更强。结论 有家族史者发生MCE及IHD的风险较高。结果提示应鼓励个体根据疾病家族史信息,及早开展生活方式干预和相关基础疾病的治疗管理。     

Coronary heart disease: pathophysiological events and risk factors

Summary Cardiovascular disease remains the major cause of morbidity and mortality in the UK, causing more than 110 000 deaths per annum. Coronary risk is multifactorial, being a composite of genetic and environmental determinants. Its major risk factors include hypertension, dyslipidaemia, obesity, plasma clotting factor concentrations, smoking and diabetes mellitus. The overall heritability of coronary heart disease has been estimated to be between 15 and 50%, and hence, there is a substantial potential role for environmental factors, including diet, to modify coronary risk. Studies in experimental animal models have permitted a more detailed analysis of the cellular events by which atherosclerosis is initiated and progresses. This work has identified the endothelium as a primary site of injury, leading to endothelial dysfunction. Detailed histological and radiological studies in man have led to the identification of features of atherosclerotic plaques that make them more vulnerable to abrupt rupture. The possible role of infection and inflammation in this process is supported by epidemiological data. These new insights into the pathogenesis of atherosclerosis have been accompanied by the identification of a new generation of risk factors.     

Relation between diet composition and coronary heart disease risk factors.

STUDY OBJECTIVE--The aim was to evaluate dietary intakes and their correlation to some risk factors for coronary heart disease. DESIGN--The study was a population based survey with random sample selection stratified by age and sex. PARTICIPANTS--352 adults living in a small town in Northern Italy took part in the study. Response rate was 46% among females and 48% among males. Refusal to take part was mainly due to the large number of tests involved. MEASUREMENTS AND MAIN RESULTS--Diets were high in protein (animal/vegetable ratio 1.7 in women and 1.4 in men) and in fat and low in carbohydrates. The hypercholesterolaemic and atherogenic potential of the diet, evaluated by the cholesterol/saturated fat index, was high in about 50% of the population. The thiamin and riboflavin intakes were lower than the Italian recommended allowances in more than 60% of the people tested, whereas the vitamin A intake was more than adequate in about 70%. A positive association was found in the younger groups (men and women 20-39 years old) between some nutrient components (energy, alcohol, total and saturated fats) and some blood lipids. In the older people blood lipids were correlated with body mass index. CONCLUSIONS--The overall data indicate that a correlation exists between dietary intake and some risk factors for coronary heart disease; dietary intervention, at least in young adults, is suggested.     

Association of passive smoking with increased coronary heart disease risk is not explained by elevation of leucocyte count

The increased risk of coronary heart disease in cigarette smokersmay be due at least partly to an elevation of the leucocytecount Chronic passive smoking has also been found to be associatedwith an increased risk of coronary heart disease, but its effecton the leucocyte count has not been reported. In this study250 male factory employees aged 20–64 years were interviewedon smoking behaviour and exposure to environmental tobacco smoke,and blood counts were determined. Urinary cotinine was measureby radio-immunoassay and corrected for urinary creatinine concentrations.Mean leucocyte count was significantly higher among smokerscompared with non-smokers (8,666 compared to 6, 900; p<0.001).On the basis of smoking history, passive smokers had leucocytecounts similar to non-smokers. These findings were confirmedwhen leucocyte counts were compared with urine cotinine to creatinineratios. The association of haematocrlt and haemoglobin withsmoking was similar to that of leucocyte count These findingssuggest that any association of passive smoking with coronaryheart disease is not through an elevation of leucocyte count.     

Evaluation of coronary heart disease risk model by carotid ultrasonography in the occupational setting--intima-media thickness and coronary heart disease risk]

Recently, because of an increase in aged workers with high risk health conditions in Japan, it is becoming necessary to have a preventive control system for work-related diseases, such as coronary heart disease. We have already built a system by applying the prediction model of Framingham's risk equation for management after an annual check-up since 1999. At that time, we considered the relationship between CHD risk and intimamedia thickness (IMT) as an index of actual atherosclerosis. Correlation coefficients among max IMT, CHD risk and the several health factors in the corporate annual health check-up were obtained by Spearman's method. Significant associations with max IMT were only for CHD risk and systolic blood pressure. Correlation coefficients were 0.30 and 0.21 for CHD risk and systolic blood pressure, respectively. Furthermore, when we divided findings into those for the atherosclerotic and non-atherosclerotic groups defined by a max IMT over 1.1 mm or less, the difference between the two groups in CHD risks was investigated by t-test. The CHD risk for the atherosclerotic group was revealed to be significantly higher than that for the non-atherosclerotic group, with the means +/- SD in the two groups being 21.4 +/- 9.4% and 17.0 +/- 7.7%, respectively. CHD risk was therefore concluded to be important for the objective index of atherosclerosis from the viewpoint of high-risk-strategy in the worksite.     

Passive smoking and the risk of coronary heart disease

Over the past 10 years it has become clear that passive smoking is correlated with an increased risk of coronary heart disease. The relative risk of 25-30% is comparable to that of lung cancer due to passive smoking. Since coronary heart disease is the most common cause of death, it is likely that passive smoking causes many more deaths from coronary heart disease than from lung cancer. For the Netherlands, yearly figures of 2,500 to 4,000 deaths from coronary heart disease due to passive smoking are estimated. In other words, of every 10 deaths from coronary heart disease due to cigarette smoke, one is caused by passive smoking. A rigorous ban on smoking is advocated, both in public places and at home.