Twenty-five-year coronary mortality trends in the seven countries study using the accelerated failure time model

The accelerated failure time model (AFT) was tested in the 25-year experience of the Seven Countries Study, to describe the shape of hazard for coronary heart disease (CHD) mortality during long-term follow-up. Sixteen cohorts of men aged 40–59 at entry were enrolled in eight countries (USA, Finland, The Netherlands, Italy, Croatia, Serbia, Greece and Japan) for a total of 12,763 subjects. Risk factors were measured and CHD mortality data collected during 25 years. The AFT incorporating the Weibull survival distribution was applied to the pooled cohorts of each country, with CHD mortality as end-point. Cumulative hazards and the annual hazard for CHD mortality were estimated during 25 years and compared among countries. The annual hazard for CHD in 25 years tended to reduce relatively or flatten out in the northern American and northern European countries, exponentially increased in Serbia and Japan, and increased moderately in the other countries of southern Europe. Positive correlations were found between the shape of the hazard curve and population mean risk factor changes (serum cholesterol and systolic blood pressure) observed during the first 10 years follow-up. The Japanese group was an outlier. The countries with the largest relative decline in the annual hazard function were the same where, during the same historical period, the largest decreases in official death rates from CHD were recorded and vice versa. The curve shape in the annual hazard for CHD mortality in different countries seems related to changes in mean levels of serum cholesterol and systolic blood pressure.     

Cardiovascular risk factors as determinants of 25-year all-cause mortality in the seven countries study

This analysis aims at describing all-cause mortality and their determinants in 16 cohorts of middle-aged men of eight nations. A total of 12,763 men aged 40–59 years were enrolled in the late 1950s and early 1960s in 16 cohorts located in the USA, Finland, The Netherlands, Italy, Croatia, Serbia, Greece and Japan. The highest death rates were found in Slavonia–Croatia, due to high rates of infectious diseases and violence (death rate of 610 per 1000), and in East Finland due to high rates from coronary heart disease (death rate of 597 per 1000). The lowest death rates were found in a highly educated group in Belgrade, Serbia (death rate 295 per 1000) and in Crete, Greece (death rate 314 per 1000). The ecological analysis showed no significant relationship between mean risk factor levels and all-cause death rates except for the direct association with systolic blood pressure during the first 15 years follow-up. Individual multivariate analysis on eight national pools showed that age, systolic blood pressure, and smoking habits are direct, significant, and universal long-term predictors of all-cause mortality. Serum cholesterol, physical activity and body mass index were so only in some areas. Multivariate coefficients were similar across nations. Pooled hazards ratios were 1.55 for a difference of 5 years of age (CI: 1.51–1.59); 1.23 for 10 cigarettes smoked per day (CI: 1.20–1.26); 0.91 for one unit (based on three grades) of physical activity score (CI: 0.87–0.95); 1.04 for 1 mmol/l of serum cholesterol (CI: 1.02–1.07); and 0.93 for three units of body mass index (CI: 0.91–0.96). In conclusion some cardiovascular risk factors predict long-term risk of all-cause mortality in different cultures.     

Food intake patterns and 25-year mortality from coronary heart disease: Cross-cultural correlations in the Seven Countries Study

In the Seven Countries Study, associations between the intake of food-groups and 25-year mortality from coronary heart disease (CHD, defined as sudden coronary death or fatal myocardial infarction) were investigated. Baseline surveys were carried out between 1958 and 1964. A number of individual characteristics were measured in 12,763 middle-aged men belonging to 16 cohorts in seven countries (USA, Finland, The Netherlands, Italy, former Yugoslavia, Greece and Japan). Dietary information was collected in sub-samples using the weighed record method. Vital status of all participants was verified at regular intervals during 25 years of follow-up and the underlying cause of death was adjudicated. Eighteen different food-groups and combinations were considered for comparison among cohorts. Large differences in food-group consumption were seen, with high consumption of dairy products in Northern Europe, meat in the USA, vegetables, legumes, fish, and wine in Southern Europe, and cereals, soy products, and fish in Japan. Population death rates from CHD showed large differences, ranging from 268 per 1000 in East Finland to 25 per 1000 in Crete, Greece. Animal food-groups were directly correlated, and vegetable food-groups (except potatoes) as well as fish and alcohol were inversely correlated with CHD mortality. Univariate analysis showed significant positive correlation coefficients for butter (R = 0.887), meat (R = 0.645), pastries (R = 0.752), and milk (R = 0.600) consumption, and significant negative correlation coefficients for legumes (R = –0.822), oils (R = –0.571), and alcohol (R = –0.609) consumption. Combined vegetable foods (excluding alcohol) were inversely correlated (R = –0.519), whereas combined animal foods (excluding fish) were directly correlated (R = 0.798) with CHD death rates. Multivariate stepwise analysis selected butter, lard+margarine and meat as significant predictors and produced an R² of 0.922. These findings were confirmed by factor analysis. These cross-cultural analyses are consistent with the hypothesis that dietary patterns are important determinants of differences in population CHD death rates, and confirm the opposite effects on apparent risk of animal and vegetable foods.     

Comparison of risk factors for coronary heart disease in Dresden and Münster

Trend analyses based on WHO statistics for average life expectancy, age-standardized cardiovascular (CVD) morbidity and mortality show significant differences between the former German Democratic Republic (GDR) and the former Federal Republic of Germany (FRG). To investigate whether this is due to a different prevalence of cardiovascular risk factors, the Dresden Cardiovascular Risk and Nutrition (DRECAN) study was conducted using the complete methodology of the Prospective Cardiovascular Münster (PROCAM) study, i.e., the same methods and strict quality controls, with an exchange of specimens between both laboratories. The results were compared with those of an adjusted subpopulation of the PROCAM study.Even before unification there were only small differences in lipoprotein profiles between West and East Germany, 10 months after unification these differences were minimal. The survey does not sufficiently explain the differences in CHD morbidity and mortality between Western and Eastern Germany. Further analyses of the nutritional aspects will show whether the change, in available foodstuffs after unification has led to substantially changed nutritional habits, and whether this might explain some of the results. DRECAN-Team; G. Assmann^2,3, S. Bergmann¹, P.H. Epping², T. Fraidt¹, J. Heinrich², W. Jaross¹, H. Martin², S. Petersen², M. Sandkamp³, B. Schottmann¹, H. Schulte², B. Siegert¹, H. Thulin¹ & U. Wahrburg²     

The prediction of coronary heart disease in different population samples

Two population samples of men aged 46–65 years were examined for the measurement of some cardiovascular risk factors and followed up for 6.5 years. The two groups were: 1) 3338 men belonging to occupational groups examined in Rome (ROG) in 1979–81 and 2) 1543 men belonging to two demographic samples of rural areas located in northern and central Italy (IRA) examined in 1965. In men free from previous myocardial infarction the rate of fatal coronary events was 18.0 in the ROG group and 17.5 per 1000 in the IRA group.Five established risk factors (age, systolic blood pressure, serum cholesterol, cigarette consumption and body mass index) were used in a multivariate model for predicting coronary deaths.The coefficients of the multiple logistic function were similar in the two populations group. However, when the IRA coefficients were applied to the ROG factors, they predicted 43 events instead of 58 (under-estimation of 26%; p < 0.05), whereas the ROG coefficients predicted 31 events instead of 26 in the IRA sample (over-estimation of 19%; p = n.s.).A model which included the pool of the two populations and a dummy-variable for the identification of each of them, suggested that being a member of the ROG group is accompained, everything else being equal, by an extra risk of 26%.Corresponding author.     

C反应蛋白水平与传统冠心病危险因素分析

目的了解江苏省人群C反应蛋白（CRP）的水平与传统冠心病（CHD）危险因素的关系。方法通过“江苏省多代谢异常和代谢综合征综合防治研究”资料，比较高敏C反应蛋白（hs—CRP）（hs—CRP：1～2．99mg／L和≥3mg／L）与传统CHD危险因素：体重指数（BMI）、吸烟、高血压、高血糖、高胆固醇、高三酰甘油、低高密度脂蛋白胆固醇、体力活动缺乏等的关系。结果高hs—CRP罹患率均随血压、血糖、胆固醇、三酰甘油、BMI、吸烟、体力活动（无、轻、中、重）增加而增高，但当hs-CRP（1-2．99mg／L）时，传统CHD危险因素中大部分未表现出显著联系；随着Framingham心脏积分（5个危险因素）合并数量增加，高hs-CRP呈明显的等级性变化趋势；logistic回归分析表明，hs—CRP（≥3mg／L）时，BMI、三酰甘油、高血压、高密度脂蛋白胆固醇、吸烟、血糖的OR值均有统计学意义，但hs—CRP（1～2．99mg／L）时，传统CHD危险因素的OR估计值大部分无统计学意义；男性中60．98％和女性中59．02％的高CRP可以归因于传统CHD危险因素。结论传统CHD危险因素与hs—CRP水平关系密切，目前在临床上、人群研究中根据CRP水平的高低判断CHD风险的实际意义值得进一步探讨。     

不同性别冠心病患者危险因素及冠状动脉病变特点分析

目的 分析不同性别冠心病(CHD)患者危险因素及其冠状动脉(冠脉)病变的特点.方法 纳入2009年1月至2011年1月在解放军总医院经冠脉造影确诊为CHD患者共3765例(男性2661例,女性1104例),收集患者各类临床资料及冠脉病变数据.根据患者年龄和性别进行分层,应用logistic回归模型分析CHD传统危险因素及冠脉病变的特点.结果 (1)女性发病年龄迟于男性,且合并CHD传统危险因素多;女性随年龄增长,吸烟的比例下降,血脂异常和糖尿病的比例显著升高.男性患者中,吸烟是最常见的危险因素.(2)性别间比较的logistic回归模型提示,糖尿病可显著增加女性罹患CHD的风险(OR=2.05,95％CI:1.49～ 2.81,P＜0.001),而吸烟则可明显增加男性罹患CHD的风险(OR=9.27,95％CI:7.68～11.19,P＜0.001).(3)随着年龄增长,女性患者冠脉病变支数增加,血管狭窄程度加重;而男性冠脉病变程度无随年龄增长而变化的趋势.结论 不同性别的CHD患者在不同年龄段具有不同的危险因素和冠脉病变特点.糖尿病和血脂异常似对女性冠脉病变的影响较大,而吸烟则对男性影响较大.     

冠心病和慢性牙周炎相关性研究

目的 探讨冠心病与慢性牙周炎的相关关系。方法 515例“胸部不适”的患者，经病史和选择性冠状动脉造影结果分为冠心病组277例、对照组238例，对所有受检者均进行牙周状况的检查，测量全口牙周袋深度和牙周附着丧失，慢性牙周炎的诊断参照Armitage推荐的标准，同时对冠心病其他常见的危险因素进行比较。结果 冠心病组慢性牙周炎患病率为54．9％，而对照组仅为29．9％，两者差异有统计学意义（P〈0.001）。单因素分析发现冠心病组患者甘油三酯、血糖、白细胞计数、高血压及吸烟的发生率均显著高于对照组（P〈0．01～0．001）；而高密度脂蛋白胆固醇（HDLC）则显著低于对照组（P〈0．叭）。多因素非条件loglstie回归分析，仅慢性牙周炎、糖尿病、高血压及HDL-C与冠心病显著相关。慢性牙周炎和冠心病不仅有统计学上的关联，且具有明显的剂量反应关系，即随着牙周炎程度的加重患冠心病的危险也增大（P〈0．001），且随牙周炎程度的加重，罹患冠心病的程度亦进一步加重。结论 慢性牙周炎可能是冠心病的独立危险因素，慢性牙周炎可能增加冠心病发生的风险程度，且随着牙周炎程度的加重，罹患冠心病的严重程度也增大。     

2017-2018年邯郸市城区居民冠心病风险评估

目的 调查2017-2018年邯郸市城区居民冠心病的患病风险,为冠心病防治提供科学依据.方法 选择邯郸市某城区1 546位居民为为研究对象,根据冠状动脉狭窄情况将其分为冠心病组未患冠心病组,收集两组的体征指标和实验室检查结果,采用单因素和多因素logistic回归模型分析冠心病的危险因素.结果 根据相关性分析结果,LD...     

The relationship between education and risk factors for coronary heart disease

In nine samples of adult populations (2707 males and 2871 females, aged 20–59 years) we studied the relationship between educational level and several lifestyle factors at risk for coronary heart disease (CHD), (i.e., smoking, alcohol consumption, dietary fat intake, sedentary behaviour at work and leisure) and the association between education and certain CHD risk factors (i.e., total cholesterol, HDL-cholesterol, triglycerides, systolic and diastolic blood pressure, body mass index). The data were analyzed separately in samples from North, Central and Southern Italy. The results show that educational level is often associated to the lifestyle factors considered here. This association was positive for both men and women for physical activity at leisure and work stress and only for women with respect to smoking. It was negative for both men and women for alcohol consumption and physical activity at work and for men only for cigarette smoking. The age-adjusted mean levels of the CHD risk factors show some significant differences among subjects with different educational levels, which were not always the same for the three geographical areas. This was with the exception of BMI in females, which appears negatively associated to education in all areas. These differences decreased after adjustments were made for daily cigarette smoking, wine consumption and dietary fat intake. Education seems to play a determining role in lifestyle, however its direct and indirect effects on some major CHD risk factors are somewhat different in areas at different socio-economic conditions.     

冠心病合并慢性心力衰竭患者5年全因死亡生存分析与可解释性研究

目的  通过机器学习算法和SHAP(shapley additive explanations)方法分析冠心病(coronary heart disease,CHD)合并慢性心力衰竭(chronic heart failure, CHF)患者全因死亡的风险因素。方法  选择山西省两所三级甲等医院诊断为CHD合并CHF患者2 648例。利用XGBoost方法筛选出的变量,分别构建Cox、随机生存森林(random survival forests, RSF)、XGBoost模型;应用SHAP进行模型可解释性分析。结果  利用XGBoost方法构建的预测模型具有最高预测性能,其一致性指数(concordance index, C-index)为0.902(0.900~0.915)。模型显示,年龄、N端前脑钠肽、SBP、肌酐越高,患者死亡风险越高;糖尿病(diabetes mellitus,DM)、中枢神经系统性疾病、他汀类药物也是影响患者预后的重要影响因素。结论  XGBoost方法所构建的生存分析预测模型能够更准确地评估患者不良预后,结合SHAP可以对患者的个体化风险预测提供明确解释,有助于辅助医生对患者进行个性化临床治疗。     

影响冠心病患者经皮冠状动脉介入治疗术后死亡率的危险因素分析

目的 分析影响经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）术后死亡的危险因素。方法 选取2006年1月1日~2011年6月30日初次在北京大学人民医院、北京东直门中医院、沧州市中心医院和洛阳市中心医院4家医院接受PCI治疗并置入药物洗脱支架的冠心病患者为研究对象,对其术后死亡率以及影响死亡率的相关因素进行分析。结果 共随访患者3 511人（85.4%）,PCI术后死亡率是4.6%（161/3 511）,多因素分析结果显示:年龄（HR=1.086,95%CI:1.059~1.113,P<0.001）、糖尿病（HR=1.807,95%CI:1.205~2.709,P=0.004）、吸烟（HR=1.873,95%CI:1.205~2.709,P=0.002）、贫血（HR=1.909,95%CI:1.266~2.879,P=0.002）、左心射血分数<50%（HR=2.546,95%CI:1.558~4.162,P<0.001）和双联抗血小板治疗（dual antiplatelet therapy,DAPT）时间<1年（HR=0.029,95%CI:0.013~0.067,P<0.001）与患者PCI术后死亡率相关。结论 年龄、糖尿病、吸烟、贫血、心功能不良和DAPT时间<1年是影响冠心病患者PCI术后死亡率的危险因素,应该给予重视和合理干预。     

冠心病患者阿司匹林抵抗与炎症因子相关性研究

目的探讨冠心病患者阿司匹林抵抗（AR）与炎症的关系。方法对110例冠心病心绞痛服用阿司匹林患者及健康对照组采用比浊法测定花生四烯酸（AA）、二磷酸腺苷（ADP）诱导的血小板聚集率，按标准将患者分为阿司匹林抵抗（AR）组、阿司匹林半抵抗（ASR）组和阿司匹林敏感（AS）组；测定血常规，放免法测定白细胞介素-1 β（IL-1β）、白细胞介素-6（IL-6）及超敏C-反应蛋白（hs-CRP）。结果入选患者AR发生率为2．73％；ASR发生率为7．27％。其中ADP诱导者占5．45％，AA诱导者占1．82％；AR或ASR合计为10．00％，而AS发生率为90．00％。对各组hs-CRP、IL-1β及IL-6三种炎症因子研究发现，AR与IL-1β无关；AR组或ASR组患者虽然hs-CRP呈上升趋势，但较AS组差异无统计学意义，而IL-6则较AS组显著上升。结论hs-CRP、IL-1β不适合作为AR的预测和筛查指标，而IL-6的升高与AR密切相关。     

老年急性脑梗死合并冠心病的危险因素分析

目的分析老年急性脑梗死合并冠心病的危险因素,为防治老年急性脑梗死合并冠心病提供参考。方法选取2013年1月—2014年3月我院治疗的93例老年急性脑梗死合并冠心病患者作为临床研究对象,另选取同期治疗的90例单纯老年急性脑梗死患者作为对照组,比较两组高血压、糖尿病、血脂及血糖等生化检查的差异性,应用Logistic回归方程分析老年急性脑梗死合并冠心病的临床危险因素。结果观察组患者BMI为（28.7±4.6）kg/m2,SBP为（170.6±17.5）mmHg,TG为（2.9±0.6）mmol/L,LDL-C为（4.3±0.5）mmol/L,TC为（5.8±1.9）mmol/L,FBG为（8.4±2.5）mmol/L,2hPG为（14.3±2.9）mmol/L,年龄为（71.86±7.96）岁,吸烟共68例,高血压共74例,糖尿病共,46例,血脂异常共39例,显著高于对照组患者,对照组BMI 22.6±4.3kg/m2,SBP为（142.3±12.9）mmHg,TG为（1.7±0.7）mmol/L,LDL-C为（3.1±0.6）mmol/L,TC为（4.6±1.4）mmol/L,FBG为（5.7±2.8）mmol/L,2hPG为（10.6±2.2）mmol/L,年龄为（65.29±7.58）岁,吸烟共51例,高血压共55例,糖尿病共24例,血脂异常共26例（P〈0.05）;Logistic回归方程分析显示年龄、吸烟、肥胖、高血压、高血糖以及高血脂均为老年急性脑梗死合并冠心病的危险因素,糖尿病及高LDL-C血症为独立危险因素。结论老年急性脑梗死合并冠心病的独立危险因为糖尿病及高LDL-C血症,早期干预危险因素,有利于防治心脑血管事件。     

冠心病患者阿司匹林抵抗与炎症因子相关性研究

目的探讨冠心病患者阿司匹林抵抗(AR)与炎症的关系。方法对110例冠心病心绞痛服用阿司匹林患者及健康对照组采用比浊法测定花生四烯酸(AA)、二磷酸腺苷(ADP)诱导的血小板聚集率,按标准将患者分为阿司匹林抵抗(AR)组、阿司匹林半抵抗(ASR)组和阿司匹林敏感(AS)组;测定血常规,放免法测定白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)及超敏C-反应蛋白(hs-CRP)。结果入选患者AR发生率为2.73%;ASR发生率为7.27%,其中ADP诱导者占5.45%,AA诱导者占1.82%;AR或ASR合计为10.00%,而AS发生率为90.00%。对各组hs-CRP、IL-1β及IL-6三种炎症因子研究发现,AR与IL-1β无关;AR组或ASR组患者虽然hs-CRP呈上升趋势,但较AS组差异无统计学意义,而IL-6则较AS组显著上升。结论hs-CRP、IL-1β不适合作为AR的预测和筛查指标,而IL-6的升高与AR密切相关。     

民航飞行员冠心病危险因素与冠状动脉病变程度的相关性分析

目的 探讨飞行员冠心病的危险因素与冠状动脉病变严重程度之间的关系.方法 研究对象为2002-2011年在中国民用航空局民用航空医学中心进行健康检查鉴定的飞行员40人.均为男性,年龄在38～60岁,均行冠状动脉造影(CAG)检查,30人确诊为冠心病,10人确诊为冠状动脉粥样硬化症.结果 ①将40名飞行员分为冠心病组和冠状动脉粥样硬化组.冠脉硬化组较冠心病组年轻(P＜0.05),体重指数(BMI)冠脉硬化组和冠心病组均＞24,收缩压、舒张压、低密度脂蛋白脂固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(rG)、空腹血糖以及危险因素数目在两组间无统计学差异.②30名冠心病飞行员按照冠状动脉病变支数分为1支病变组(17人),2支病变组(9人)和3支病变组(4人),LDL-C水平在3支病变组明显升高(P＜0.05),BMI、收缩压、舒张压、HDL-C、TG、空腹血糖以及危险因素数目在3组间差异无统计学意义.结论 飞行员冠心病严重程度与年龄、BMI、LDL-C有关,与危险因素数目无关.     

The North-East-South gradient of coronary heart disease mortality and case fatality rates in France is consistent with a similar gradient in risk factor clusters

In France, the mortality and case fatality rates of coronary heart disease follow a decreasing North–East–South gradient. The aim of the study was to evaluate the contribution of major cardiovascular risk factors to this gradient. To this end, the results of the third population survey of the WHO–MONICA Project conducted in three French geographically contrasted regions (the Urban Community of Lille in the North, the district of Bas-Rhin in the East and the district of Haute-Garonne in the South) are presented. One thousand seven hundred seventy-eight men and 1730 women aged 35–64years were randomly selected from the electoral rolls. Major coronary heart disease risk factors (hypertension, hypercholesterolemia, low high-density lipoprotein (HDL)-cholesterol, obesity, smoking, physical inactivity, diabetes) were studied. The results show that the distribution of major coronary heart disease risk factors is heterogeneous among geographical areas in France. However, the proportion of subjects with more than three risk factors is higher in the North than in the other regions and the number of subjects with no risk factor is higher in the South than in the other areas. This distribution of risk factors among regions supports the hypothesis that accumulation of coronary heart disease risk factors contributes to the decreasing North–East–South gradient of cardiovascular mortality rates in France.     

冠心病基因检测与冠心病的关联性

目的观察冠心病基因检测与冠心病是否有关联性,以及关联程度如何。方法选取120例住院患者,其中60例为冠心病人,60例为非冠心病人。年龄40—65岁。冠心病为观察A组,非冠心病为对照B组,记录性别、年龄、冠心病家族史、高血压史、糖尿病史,并均抽血行冠心病基因检测。A组选1人和B组选1人按年龄相近、性别相同配对,共形成60对。开始进行1：1条件Logistic回归分析。结果冠心病家族史、高血压史、糖尿病史、以及冠心病基因检测与冠心病均有关联性。其中冠心病基因检测与冠心病的关联程度低于其他3个因素。结论冠心病基因检测与冠心病有关联性。     

血管紧张素转换酶基因多态性与冠心病危险因素的关系

目的 探讨血管紧张素转换酶（ＡＣＥ）基因多态性与冠心病危险因素的关系。方法 应用聚合酶链反应技术和遗传学方法,测定１５９名汉族正常人、１４８例冠心病患者的ＡＣＥ基因插入／缺失（Ｉ／Ｄ）多态性频率,并调查冠心病患者经内危险因素。结果①ＡＣＥ基因型分布与冠心病患者的年龄、性别、体重指数（ＢＭＩ）、收缩压、舒张压、总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、低密度脂蛋白（ＬＤＬ）、高密度脂蛋白（ＨＤＬ）、ＨＤＬ